tag:blogger.com,1999:blog-8018736458772448732024-03-16T16:43:14.402-04:00thoughts & ramblingsZack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-801873645877244873.post-12803809926376804012022-08-07T10:56:00.001-04:002022-08-08T11:43:57.138-04:00What Is Nine Leaves?<p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Before my career as a solo artist, there was Nine Leaves. A collective of 4 rappers and myself, the sole composer and non-rapper. Prior to this, I was interested in one day scoring film. After this, I didn’t give a shit about scoring film. Prior to this, I hated rap. After this, I was rapping. Prior to this, I was just a composer. After this, I was a composer, and a lyricist, and a recording artist.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">It was Nine Leaves that introduced me to the power of songwriting and the spoken word. And it was within Nine Leaves that I learned how lyrics can influence and shape the underlying music, for better or worse. I went from watching the other members react to my music, interact with it, compliment it, and transform it with their lyrics, to eventually doing the same alongside them. And I ultimately came to see the spoken word as another instrument within the orchestra. </p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Lyrics have specificity. Even the most vague lyrics will inevitably narrow the total possible interpretations that would otherwise be available to a listener. And thus, the absence of lyrics maintains a lack of specificity in music. Both states, lyrical and non-lyrical, are powerful. Both do things the other is incapable of. And so it’s no surprise that throughout my career I’ve continuously utilized both states, moving between them as desired.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Nine Leaves is where these revelations and insights all started for me. It’s the prequel to Zack Hemsey. An effort that spanned 10 years, bridging adolescence into adulthood. We were all teenage kids at the beginning, and by the end of it, most had children of their own. It was a garden of ideas, and the studio a laboratory in which we tested our experiments. Our collective explorations, our personal transformations, and our artistic evolution is all embedded in the body of work that Nine Leaves created. A body of work that up until now, has largely been unreleased, and generally ignored.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">So is the way it sometimes goes. Except I found myself going through archives, resurrecting and restoring old sessions, and remastering the entire Nine Leaves catalog. My intention was not to substantially alter the music, or attempt to “modernize” the songs in any way. Rather, it was to treat the catalog as a historical work, doing only what was necessary to ensure that it speaks as it was intended to speak at the time it was created.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">This process has been like opening up a time capsule. Much of the material I hadn’t heard in two decades. I fully expected my face to contort with embarrassment and disgust at what I was certain was going to be a sea of flaws, awful performances, and amateur mixes that were painful to listen to. But instead, I was met with the carefree attitudes of young individuals making songs simply because they wanted to, and performances that were infectious because of their purity and sincerity. Yes, it all sounded young…but it didn’t sound bad. Quite the opposite. The body of work still had value. It was still worthy of being shared.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">And so it’s my pleasure to introduce this. It’s Nine Leaves music.</p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Apple Music - <a href="https://tinyurl.com/NL-Apple">https://tinyurl.com/NL-Apple</a></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Spotify - <a href="https://tinyurl.com/NineLeaves-Spotify">https://tinyurl.com/NineLeaves-Spotify</a></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Bandcamp - <a href="https://nineleaves.bandcamp.com">https://nineleaves.bandcamp.com</a></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">Deezer - <a href="https://tinyurl.com/NL-Deezer">https://tinyurl.com/NL-Deezer</a></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px;">TIDAL - <a href="https://tidal.com/browse/artist/33583194">https://tidal.com/browse/artist/33583194</a></p>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com25tag:blogger.com,1999:blog-801873645877244873.post-82038348427348006822018-08-05T10:13:00.000-04:002018-08-05T22:07:42.000-04:00Open Letter To Jillian Michaels<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
Hi Jillian,</div>
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<span style="font-kerning: none;">I recently read your book <i><a href="https://www.amazon.com/gp/product/1623368030/ref=as_li_tl?ie=UTF8&tag=jillimicha0f-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=1623368030&linkId=4d81447310afeeb88165865e1843e8ca" target="_blank">Yeah Baby</a></i>. You maintained a calm and collected approach in discussing what are typically emotionally charged topics, and it is in that same spirit that I hope you will receive this letter. Some of the book’s content troubled me, and I’d like to offer some alternative perspectives that you may not have considered.</span></div>
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<span style="font-kerning: none;">As a background, my education in childbirth largely parallels your own: I’ve been at my wife’s side through pregnancy and birth on two occasions, and I’ve done extensive research into an assortment of birth related areas via peer-reviewed studies, professional texts, books, lectures, films, and many hours of personal discussion with experienced childbirth practitioners. Both of my children were planned home births, the first resulting in a hospital transfer 30 hours into active labor and culminating in a pharmaceutically-assisted vaginal delivery, and the second resulting in an unmedicated vaginal delivery in our house. So it is the confluence of first-hand subjective experience with academic and interpersonal research that ultimately informs both of our perspectives.</span></div>
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<span style="font-kerning: none;">To be clear, I think much of the book is excellent. It wonderfully highlights the importance of being optimally healthy prior to conceiving, along with the link between the health of the mother and baby (even into adulthood). It stresses the importance of nutrition and legitimate exercise, dispelling the myth of pregnant women being fragile and helpless. It draws attention to the myriad toxins people regularly encounter and/or ingest unknowingly, and outlines ways to avoid them. It has very good commentary on the effects of smoking and drinking alcohol while pregnant and trying to conceive. It dismisses the notion that family bed sharing is controversial or dangerous in the context of sober parents. And it illuminates the shortcomings and limitations of what doctors actually know. </span></div>
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<span style="font-kerning: none;">With that being said, I find some of the book’s other points of discussion disconcerting. </span></div>
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<span style="font-kerning: none;">After Heidi gave birth to your son, you write: <i>“I was wondering if we were ever going to have a romantic relationship again. I was being a selfish ass, I know. However, I guarantee your significant other is wondering this, too.”</i> </span></div>
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<span style="font-kerning: none;">I can guarantee you that not all significant others share your sentiment - I certainly didn’t after the birth of my children. Yes, some partners do feel ignored and/or left out in the aftermath of a birth. It's fine to acknowledge this possibility, but it’s not the responsibility of new moms to remedy this, as the book suggests - it’s the responsibility of the partner to sort their issues out and to temporarily put their needs aside. As a partner, one should be genuinely invested in doing whatever is best for mom and her needs. It’s not about the partner right now; it’s about the family they’ve (theoretically) chosen to build.</span></div>
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<span style="font-kerning: none;">The book stresses the importance of sex in maintaining a connection between partners, encouraging new moms to make a conscious effort to work around all the emotional, hormonal, sleep, and practical impediments that get in the way. You state that while <i>“sex for some can seem low on the totem pole, I can’t stress enough how critical it is to your overall long-term relationship.”</i> </span></div>
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<span style="font-kerning: none;">Yes, connection between partners is crucial - but if sex is the only means by which partners can maintain connection, then the relationship may have a bigger problem. </span></div>
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<span style="font-kerning: none;">You then offer an analogy: exercising even when you’re not in the mood results in feeling great post-workout, and so it will be with sex. Thus, the book’s final instructions with respect to intercourse and other forms of sexual relations: <i>“Do them. When you aren’t in the mood, do them anyway.”</i></span></div>
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<span style="font-kerning: none;">For those new moms who are in the mood (or who wish to do it despite feeling otherwise), they should. But for those who are disinclined, they shouldn't feel guilty about it, and they definitely don’t need outside pressure to do something about it. I’m not disputing the benefits of sex - I'm disputing the force with which you appear to advocate it, as it comes across like a mandate.</span></div>
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<span style="font-kerning: none;">You decry at length what you perceive as judgement from those who support natural childbirth toward those who choose alternative means of delivery. I agree that people shouldn’t judge others. However, let’s not pretend that all modes of delivery are equal. They simply aren’t. Stating this fact doesn’t mean medical interventions shouldn’t be utilized as and when necessary, and it doesn’t mean babies born under such circumstances are doomed. Nor does it mean mothers who elect to receive pharmaceutical and/or surgical assistance are horrible people. But it also isn't necessary to diminish the virtues of natural childbirth in order to make others feel better about their birth experience, which is what you seem to be doing.</span></div>
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<span style="font-kerning: none;">You take issue with the term “natural childbirth” which you feel implies that anything other than an unmedicated vaginal birth is <i>“unnatural.”</i> As I understand it, “natural" refers to maintaining the integrity of the birth process inherent in our biology - yes, that translates to unmedicated vaginal birth, but there’s no need to turn this into an insult. </span></div>
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<span style="font-kerning: none;">Nevertheless, you write: <i>“Um, pretty sure the birth of any human being who’s been made inside of another body…is “natural,” no matter how the child comes into this world - thank you very much.”</i> </span></div>
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<span style="font-kerning: none;">There is nothing natural about having a baby pulled out of your stomach. Is it common? Yes. Sometimes medically necessary? Yes. Natural? No. Importantly, cesarean birth not being natural has no bearing on its applicable merit. C-sections save many babies and/or mothers who would not have otherwise survived childbirth - this should be celebrated - but we don’t need to deceive ourselves that somehow it’s a natural process. It’s anything but natural, and that’s perfectly ok.</span></div>
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<span style="font-kerning: none;">The book attacks <i><a href="http://www.thebusinessofbeingborn.com" target="_blank">The Business Of Being Born</a></i> and similar documentaries for laying on guilt trips and judging women who choose anything other than natural childbirth, claiming that it’s unfair to put that kind of pressure on women. Having seen these documentaries, I’m puzzled by your critique. How is it judgmental to suggest that women have the capacity to give birth naturally? How is it unfair to inform women of the implications of medicated and/or surgical childbirth? </span></div>
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<span style="font-kerning: none;">Imagine if someone levied a charge that your book’s detailing the importance of eating organic unfairly places pressure on women, guilting those who fail to adhere to the book’s advice; or someone who accused your outlining of the consequences of smoking during pregnancy as being unfairly judgmental to those women that do smoke during pregnancy…surely you would call such characterizations of your work unfounded, misguided, and inaccurate (and rightly so). And yet, the flawed reasoning displayed by this imaginary critic seems to be reflected in your commentary on natural childbirth films.</span></div>
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<span style="font-kerning: none;">Documentaries that educate about unmedicated vaginal birth, midwifery, home birth, etc are also correcting for the cultural narrative in which women are told a) childbirth is nothing but pain and agony, b) they should be afraid of birth, c) they will certainly need medicine to get through the experience because they aren't strong enough, d) even if they are strong enough, there’s no value to be gained, and e) they should just do whatever their doctor tells them. Thus, the documentaries which you appear to disparage serve to educate and empower women, even those who ultimately choose to birth in hospitals with medical assistance.</span></div>
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<span style="font-kerning: none;">In discussing newborn GBS disease, the book summarizes the matter in a paragraph, essentially advising adherence to the CDC guidelines. While an in-depth analysis of this topic is beyond the scope of this letter, suffice it to say I believe the issue is far less straightforward than the book represents…I invite you to give <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html" target="_blank">this</a> a read, at your leisure.</span></div>
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<span style="font-kerning: none;">The book goes into detail about the birth of your son and Heidi’s birth story. The reader learns it was important to Heidi to have a natural childbirth. Not wanting to discourage Heidi outright, you tried to keep her open minded to alternative potential outcomes. You state: <i>“All I had to do was look at Heidi to see the size of her belly in comparison to her tiny hips, and I knew (or at least had a very strong feeling) that “natural childbirth” was not going to be in the cards for her.”</i> </span></div>
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<span style="font-kerning: none;">The notion that one can determine the chances of a vaginal birth based on a visual assessment of a woman’s hips and belly has no medical basis, and it naively discounts labor’s physiology, along with how such is affected by maternal position.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#1">1-4</a></sup> </span></div>
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<span style="font-kerning: none;">You write: <i>“the big day came, and big surprise, our baby did not come ‘naturally.’”</i> Heidi was a week past her due date, so the doctor <i>“deemed it best to induce labor.”</i> Detail as to what prompted the need for induction is absent. Heidi gets admitted and induced via Pitocin, after which <i>“there is no more food, just liquids.”</i> </span></div>
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<span style="font-kerning: none;">Unfortunately, the book doesn’t clarify that hospitals banning food is an outdated guideline stemming from a risk of vomiting during general anesthesia that is not applicable today, and the continued ban on food during labors with low risk is not supported by evidence.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#5">5-7</a></sup> </span></div>
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<span style="font-kerning: none;">8 hours later, Heidi dilates from 1 to 2 cm. The doctor performs a manual rupture of membranes, followed by more Pitocin. 13 hours in, she’s at 3 cm. Heidi is in a lot of pain, and you beg her to let them give her an epidural. Heidi consents. 27 hours in, 4 cm. Heidi still had not eaten since being admitted to the hospital. Heidi begins running a fever and the baby’s heartbeat goes irregular. So you take control of the situation:</span></div>
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<span style="font-kerning: none;"><i>“The whole “I am woman hear me roar” thing had gone far enough. I called our ob-gyn at 3 a.m. and said, “Get over here and cut this kid out of her now, or I’m going to MacGyver this myself with an X-Acto knife and some Xanax!””</i></span></div>
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<span style="font-kerning: none;">The ob-gyn came right away and <i>“Heidi was so depleted at this point that she had no strength to fight me.”</i> I find this statement extremely telling. Here you have a pregnant woman with a very clear set of intentions, wanting natural childbirth, but having to “fight” those around her, with her partner appearing to doubt her capacity from pregnancy through labor.</span></div>
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<span style="font-kerning: none;">Natural childbirth is every bit mental as it is physical,<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#8">8-11</a></sup> and it can derail when the mother is stressed, anxious, scared, disempowered, inhibited, self-doubting, etc. Even in the best of circumstances it can take 100% of a woman’s focus to successfully navigate labor unmedicated, which is why anything short of complete support and unity in the birthing environment is so toxic to the process. Moreover, research shows the body’s hormonal system is crucially important in preparing and facilitating labor (among other birth-related effects), and that such hormones can be fostered or disrupted in response to both the psychological state of laboring women and medical interventions that transpire.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#12">12</a></sup> </span></div>
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<span style="font-kerning: none;">Thus, consider the stripping of Heidi’s membranes, an induced labor at 41 weeks, manual breaking of her water, administration of analgesic and synthetic hormones, presumably high levels of stress and anxiety for Heidi throughout the entire ordeal, not to mention fatigue (exacerbated by lack of food and sleep), and then ask, is it really surprising that labor didn’t “progress”? For those familiar with natural childbirth, no one is surprised at this outcome. However, you drew a different conclusion:</span></div>
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<span style="font-kerning: none;"><i>“The lesson here? Our son was 9 pounds! His shoulders were simply too broad to get past Heidi’s hips, rendering him unable to “drop” and therefore Heidi unable to dilate.”</i></span></div>
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<span style="font-kerning: none;">Or is the lesson here that subverting the innate biological processes of birth, by way of interventions, restrictions, or limitations (whether medically necessary or otherwise), has corresponding physical and mental side effects from which surgical outcomes can result? This is not an indictment of the medical model - it’s simply to say all actions have consequences. It’s also important to acknowledge that vaginal births of 9 pound babies (and heavier) do happen<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#13">13</a></sup>…it’s not science fiction; it’s human physiology.</span></div>
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<span style="font-kerning: none;">The book proceeds to discuss birthing environment. While you respect everyone’s choice of birthing environment, you strongly advocate hospital birth. I take no issue with this, in and of itself, however your characterization of home birth fails to grasp its primary motivation - that of maximizing one’s chances of having an unmedicated vaginal childbirth - and how the home environment relates to that objective.</span></div>
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<span style="font-kerning: none;">You include an excerpt from a doctor who argues that contrary to popular belief, medical interventions in labor are not profit driven. Fine, but those seeking unmedicated vaginal birth are not concerned about profiteering…they're concerned with what they perceive as unnecessary interventions that routinely take place at hospitals for a variety of reasons (arbitrary timelines, impatience, liability concerns, poor judgement, etc), and which can result in a cascade of further interventions,<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#12">12,14-18</a></sup> increasing the chances of undesirable outcomes.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#12">12,17-25</a></sup> </span></div>
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<span style="font-kerning: none;">Surprisingly, the high cesarean rate in this country does not seem to be of significance to you, as you state: <i>“30 percent of babies nowadays are delivered through C-section…most happen due to medical necessity…”</i> The actual rate is 32% and it’s patently obvious that a significant portion are not medically necessary.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#26">26-28</a></sup> Just compare US cesarean rates in hospitals to those of planned home births, the latter having C-section rates in the low single digits.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#29">29-31</a></sup> Granted, most women who plan to birth at home are considered low-risk, which does create an asymmetry in this comparison. However, according to the CDC, national cesarean rates specifically for low-risk pregnancies are still 26%,<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#32">32</a></sup> revealing a tremendous disparity. And this disparity persists even when looking at birthing centers, whose cesarean rates also average to single percentages,<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#33">33-35</a></sup> similar to planned home births. The reality is that something is artificially inflating cesarean outcomes among hospital births - failing to give credence to this is misleading in my view.</span></div>
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<span style="font-kerning: none;">The book’s argument for hospital birth essentially amounts to “better safe than sorry.” While you don’t want the reader to feel pressured, you argue that if something goes wrong it is better to have instant access to lifesaving technology. I understand and respect this perspective, although it should be weighed against a person’s individual pregnancy risk and the risks that hospitals potentially introduce (medically unnecessary intervention / cesarean, lack of food, reduced mobility, environment-induced stress response, hospital acquired infections, etc). “Better safe than sorry” can work both ways.</span></div>
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<span style="font-kerning: none;">You continue: <i>“with the birth of our son, we experienced fairly atypical complications that ultimately required pain medicine and a C-section.”</i> Except they weren’t atypical complications. In fact, they are quite common in response to the medical interventions that transpired (which was made clear in those documentaries you were criticizing). Nonetheless, you conclude: </span></div>
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<span style="font-kerning: none;"><i>“Heidi was considered “low risk” throughout her entire pregnancy. Yet, when the day came for our son to be born, he was simply too big to be pushed out vaginally. She ended up requiring all the lifesaving benefits of modern medicine that we have come to take for granted over the last century. Shit happens - why not be prepared?” </i></span></div>
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<span style="font-kerning: none;">See the above points.</span></div>
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<span style="font-kerning: none;">In discussing induction of labor, the book references ACOG’s guidelines that you can wait up to 42 weeks to induce. This begs the question, why wasn’t Heidi allowed to wait until 42 weeks? </span></div>
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<span style="font-kerning: none;">You also list scenarios in which induction will be medically required, which includes being <i>“Past term or ‘late.’”</i> I respectfully disagree. Being “late" in and of itself does not constitute a medical emergency, particularly given that estimated due dates are notoriously inaccurate anyway.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#36">36</a></sup></span></div>
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<span style="font-kerning: none;">Finally, the book outlines the various methods of induction, none of which worked for Heidi because <i>“our son was incapable of “dropping” in order to open the cervix effectively.”</i> There are many variables that influence the rate at which labor progresses and how a baby “drops” (e.g. fetal presentation, labor position, etc), but I am unaware of any medical diagnosis called “incapable of dropping.” It seems that you are conflating the fact that your son didn’t drop in that series of events with the notion that he was inherently incapable of dropping. These are not the same things. And it’s important to parse that out, as otherwise you instill in the reader an unfounded fear that big babies (or large bellies) pose some insurmountable obstacle to vaginal delivery. They don’t.</span></div>
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<span style="font-kerning: none;">Overall, I find that the book’s commentary on labor exemplifies much of what is missing from birth in modern society. It diminishes the capacity of women to withstand and navigate labor, has little to no regard for the merits of the biological forces that underpin natural childbirth, and no appreciation for how influential and important the psychology of laboring women is to the entire experience. It is also remarkable that within the entire 300+ pages of text, there is no discussion of the biomechanics of birth, alignment, or labor technique - knowledge and skills which are of direct importance and applicability to laboring women.<sup style="font-size: 9px; line-height: 8px;"><a href="https://zackhemsey.blogspot.com/2018/08/open-letter-to-jillian-michaels.html#37">37-53</a></sup> If the reader is to be armed with the information necessary to successfully navigate pregnancy and birth, as the book purports, then this information would seem to be relevant.</span></div>
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<span style="font-kerning: none;">What’s additionally saddening is the book’s recounting of how Heidi went on to struggle with breastfeeding, something that was also really important to her. The initial pediatrician told her to <i>"pump every hour to increase my milk supply, which only made me want to cry.”</i> After the baby lost 2 pounds, the choice was made to supplement breast milk with formula. Heidi writes, <i>“Eventually, I became okay with the fact that my body just wasn’t going to produce enough milk for this enormous child.”</i> </span></div>
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<span style="font-kerning: none;">It seems Heidi is left with the impression that she is a failure on account of her body simply not being good enough to both deliver and breastfeed her baby. She writes, <i>“I barely spoke for 3 months"</i> and was <i>“unable to snap back into life or be myself again after what felt to me like a somewhat traumatic birth experience.”</i> </span></div>
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<span style="font-kerning: none;">My heart breaks for her. Her choice of wording is interesting, in that she qualifies the experience as being “somewhat” traumatic. My sense is that she feels conflicted speaking honestly about the matter, given the upbeat positive context of her partner’s pregnancy book.</span></div>
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<span style="font-kerning: none;">Well, Heidi if you’re reading this - as traumatic as your birthing experience may have been, you found the light at the end of the tunnel. You encountered obstacles you could not have anticipated, and some which had no business being there. But you found a way through them, and that requires its own degree of strength. Never make the mistake of thinking you are inferior or incapable…you are quite the contrary.</span></div>
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<span style="font-kerning: none;">Lastly, it’s imperative that we recognize a woman is not weak for choosing to receive pain management. But a society that teaches women they don’t have the ability to endure natural childbirth does create weakness. Not believing in women does create weakness. Scaring women without practical cause does create weakness. Moreover, championing natural childbirth does not intrinsically entail disdain for pharmaceutical or medical assistance. That Heidi (or anyone else) had a C-section is not a tragedy. But it would indeed be tragic if a woman wasn’t genuinely supported and given the best chances of having the birth that was important to her, regardless of what the outcome would have been. Mothers are always going to have strong bonds with their babies, regardless of the mode of delivery. And birth is always capable of being positive and transformative, regardless of the methods and means utilized. </span></div>
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<span style="font-kerning: none;">I have great respect for what you set out to achieve in writing your book. It is informative and truly helpful in many respects. And I know you honestly want to assist readers in grappling with the overwhelming mountain that is pregnancy and birth, and help guide them to optimal outcomes. You have a tremendous influence - what you say matters. As a kindred spirit who shares your aims, this is why I felt compelled to write the above words. May you do with them as you wish.</span></div>
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<span style="font-kerning: none;">Sincerely,</span></div>
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<span style="font-kerning: none;">Zack Hemsey</span></div>
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<span style="-webkit-font-kerning: none;"><a name="1">1</a>. André Michel SC, Marincek B, et al. </span><span style="font-kerning: none;"><a href="http://cds.ismrm.org/ismrm-2001/PDF7/2080.pdf" target="_blank">The effect of maternal posture on pelvic outlet MR measurements.</a> Proc. Intl. Soc. Mag. Reson. Med 9 (2001).</span><br /></div></div>
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<span style="-webkit-font-kerning: none;"><a name="2">2</a>. Michel SC, et al. </span><span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/12239066" target="_blank">MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions.</a> </span><span style="-webkit-font-kerning: none;">AJR Am J Roentgenol. </span><span style="font-kerning: none;">2002 Oct;179(4):1063-7.</span><span style="-webkit-font-kerning: none;"> </span></div>
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<span style="-webkit-font-kerning: none;"><a name="3">3</a>. Golay J, et al. </span><span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/8240610" target="_blank">The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being.</a> </span><span style="-webkit-font-kerning: none;">Birth. </span><span style="font-kerning: none;">1993 Jun;20(2):73-8. </span></div>
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<span style="font-kerning: none;"><a name="4">4</a>. Pyanov M. </span><a href="https://www.bellybelly.com.au/birth/small-pelvis-big-baby-cpd/" target="_blank">Small Pelvis? Big Baby? Here’s The Truth About CPD.</a> BellyBelly June 2018. </div>
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<a name="5">5</a>. Singata M, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23966209" target="_blank">Restricting oral fluid and food intake during labor.</a> Cochrane Database Syst Rev. 2013 Aug 22;(8):CD003930. </div>
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<a name="6">6</a>. American Society of Anethesiologists. <a href="https://www.asahq.org/about-asa/newsroom/news-releases/2015/10/eating-a-light-meal-during-labor" target="_blank">Most healthy women would benefit from light meal during labor.</a> November 6, 2015. </div>
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<a name="7">7</a>. Medscape. <a href="https://www.medscape.com/viewarticle/853485" target="_blank">Researchers Question Ban on Solid Food During Labor.</a> October 30, 2015. </div>
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<a name="8">8</a>. Gaskin IM. <a href="http://inamay.com/going-backwards-the-concept-of-pasmo/" target="_blank">Going backwards: the concept of ‘pasmo’.</a> Practicing Midwife, 2013 Sep;6(8):34-7. </div>
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<a name="9">9</a>. Whitburn LY, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/24820004?dopt=Abstract" target="_blank">Women's experiences of labour pain and the role of the mind: an exploratory study.</a> </span>Midwifery. <span style="font-kerning: none;">2014 Sep;30(9):1029-35. </span></div>
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<a name="10">10</a>. Whitburn LY, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28558667" target="_blank">The meaning of labour pain: how the social environment and other contextual factors shape women's experiences.</a> </span>BMC Pregnancy Childbirth. <span style="font-kerning: none;">2017 May 30;17(1):157. </span></div>
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<a name="11">11</a>. Whitburn LY, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/29685345" target="_blank">The nature of labour pain: An updated review of the literature.</a> </span>Women Birth. <span style="font-kerning: none;">2018 Apr 20. pii: S1871-5192(17)30629-7. </span></div>
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<span style="font-kerning: none;"><a name="12">12</a>. </span>Buckley SJ. <a href="http://www.nationalpartnership.org/research-library/maternal-health/hormonal-physiology-of-childbearing.pdf" target="_blank">Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care.</a> Childbirth Connection, January 2015. </div>
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<a name="13">13</a>. Hard statistics on birth weight by method of delivery are elusive, however any experienced midwife will tell you vaginal birth of babies weighing 9+ pounds is not an exceedingly rare occurrence, and there are an abundance of anecdotal cases reported in a variety of literature that illustrate the point (for example, see Part 1 of <i><a href="https://www.amazon.com/Ina-Mays-Guide-Childbirth-Gaskin/dp/0553381156/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=&dpID=51wXPOOPylL&preST=_SY344_BO1,204,203,200_QL70_&dpSrc=detail" target="_blank">Ina May’s Guide To Childbirth</a></i>, pg 208 of Katy Bowman’s <i><a href="https://nutritiousmovement.com/product/alignment-matters/" target="_blank">Alignment Matters</a></i>, the comments section <a href="https://www.bellybelly.com.au/birth/macrosomia-5-myths/" target="_blank">here</a>, etc).</div>
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<a name="14">14</a>. Tracy SK, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/17467355" target="_blank">Birth outcomes associated with interventions in labour amongst low risk women: a population-based study.</a> </span>Women Birth. <span style="font-kerning: none;">2007 Jun;20(2):41-8. </span></div>
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<a name="15">15</a>. Rossigno M, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/24654639" target="_blank">Interrelations between four antepartum obstetric interventions and cesarean delivery in women at low risk: a systematic review and modeling of the cascade of interventions.</a> </span>Birth. <span style="font-kerning: none;">2014 Mar;41(1):70-8. </span></div>
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<a name="16">16</a>. National Institute for Health and Care Excellence. <a href="https://www.nice.org.uk/guidance/cg190/chapter/Recommendations" target="_blank">Intrapartum care for healthy women and babies.</a> Clinical guideline [CG190]. Section 1.1 Place of birth. December 2014, updated February 2017. </div>
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<a name="17">17</a>. Jansen L, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647734/" target="_blank">First do no harm: interventions during childbirth.</a> </span>J Perinat Educ. <span style="font-kerning: none;">2013 Spring;22(2):83-92. </span></div>
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<span style="font-kerning: none;"><a name="18">18</a>. Lothian JA. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25411540" target="_blank">Healthy birth practice #4: avoid interventions unless they are medically necessary.</a> </span>J Perinat Educ. <span style="font-kerning: none;">2014 Fall;23(4):198-206. </span></div>
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<a name="19">19</a>. Anim-Somuah M, et al. <span style="-webkit-font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/22161362" target="_blank">Epidural versus non-epidural or no analgesia in labour.</a> </span>Cochrane Database Syst Rev. <span style="-webkit-font-kerning: none;">2011 Dec 7;(12):CD000331. </span></div>
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<a name="20">20</a>. Adams J, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/25649472" target="_blank">Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women.</a> </span>Midwifery. <span style="font-kerning: none;">2015 Apr;31(4):458-63. </span></div>
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<a name="21">21</a>. Alfirevic Z, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28157275" target="_blank">Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.</a> Cochrane Database Syst Rev. 2017 Feb 3;2:CD006066. </span></div>
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<span style="font-kerning: none;"><a name="22">22</a>. Segal S. <a href="https://www.ncbi.nlm.nih.gov/pubmed/20861420" target="_blank">Labor epidural analgesia and maternal fever.</a> Anesth Analg. 2010 Dec;111(6):1467-75. </span></div>
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<span style="font-kerning: none;"><a name="23">23</a>. Klein MC. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481670/" target="_blank">Does epidural analgesia increase rate of cesarean section?</a> Can Fam Physician. 2006 Apr 10; 52(4): 419–421. </span></div>
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<span style="font-kerning: none;"><a name="24">24</a>. Chantry, CJ, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/21173007" target="_blank">Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance.</a> Pediatrics. 2011 Jan;127(1):e171-9. </span></div>
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<a name="25">25</a>. Lindholm A, Hildingsson I. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/25998874" target="_blank">Women's preferences and received pain relief in childbirth - A prospective longitudinal study in a northern region of Sweden.</a> </span>Sex Reprod Healthc. <span style="font-kerning: none;">2015 Jun;6(2):74-81. </span></div>
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<span style="-webkit-font-kerning: none;"><a name="26">26</a>. Ye J, et al. </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/24720614" target="_blank">Searching for the optimal rate of medically necessary cesarean delivery.</a> Birth. 2014 Sep;41(3):237-44. </div>
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<a name="27">27</a>. Pallasmaa N, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23808409#" target="_blank">Variation in cesarean section rates is not related to maternal and neonatal outcomes.</a> Acta Obstet Gynecol Scand. 2013 Oct:92(10):1168-74. </div>
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<a name="28">28</a>. Glantz JC. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23281946" target="_blank">Obstetric variation, intervention, and outcomes: doing more but accomplishing less.</a> Birth. 2012 Dec;39(4):286-90. </div>
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<a name="29">29</a>. Johnson KC, Davids BA. <a href="https://www.ncbi.nlm.nih.gov/pubmed/15961814" target="_blank">Outcomes of planned home births with certified professional midwives: large prospective study in North America.</a> BMJ. 2005 Jun 18;330(7505):1416. </div>
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<a name="30">30</a>. Cheyney M, et al. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.12172" target="_blank">Outcomes Of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.</a> Journal of Midwifery & Women’s Health. 2014 Jan-Feb;59(1):17-27. </div>
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<a name="31">31</a>. The Farm Midwifery Center. <a href="http://thefarmmidwives.org/preliminary-statistics/" target="_blank">Statistics 1970-2010.</a> </div>
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<a name="32">32</a>. National Vital Statistics Reports. <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf" target="_blank">Births: Final Data for 2015.</a> Vol 66, No 1, January 5, 2017. Table C. </div>
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<a name="33">33</a>. Rooks JP, Weatherby NL, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/2687692" target="_blank">Outcomes of care in birth centers. The National Birth Center Study.</a> N Engl J Med. 1989 Dec 28;321(26):1804-11. </div>
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<a name="34">34</a>. Stapleton SR, et al. <a href="https://pdfs.semanticscholar.org/5ae5/9100789581ebb7e277dd76401e635c34faed.pdf" target="_blank">Outcomes Of Care in Birth Centers: Demonstration of a Durable Model.</a> J Midwifery Women’s Health. 2013 Jan-Feb;58(1):3-14. </div>
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<a name="35">35</a>. Thornton P, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/27926797" target="_blank">Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.</a> J Midwifery Women’s Health. 2017 Jan;62(1):40-48. </div>
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<a name="36">36</a>. Jukic AM, et al. <a href="https://academic.oup.com/humrep/article/28/10/2848/620772" target="_blank">Length of human pregnancy and contributors to its natural variation.</a> Hum Reproduc. <span style="-webkit-font-kerning: none;">2013 Oct;28(10):2848-55. </span> </div>
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<span style="font-kerning: none;"><a name="37">37</a>. </span>Bowman K. <a href="https://nutritiousmovement.com/the-hunting-and-gathering-mama/" target="_blank">The Hunting And Gathering Mama.</a> Nutritious Movement. March 2010. </div>
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<a name="38">38</a>. Bowman K. <a href="https://nutritiousmovement.com/natural-pregnancy-natural-birth/" target="_blank">Natural Pregnancy, Natural Birth.</a> Nutritious Movement. July 2010. </div>
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<a name="39">39</a>. Bowman K. <a href="https://nutritiousmovement.com/when-push-comes-to-shove/" target="_blank">When Push Comes To Shove.</a> Nutritious Movement. March 2011. </div>
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<a name="40">40</a>. Bowman K. <a href="https://nutritiousmovement.com/aligning-or-relaxin-before-pregnancy/" target="_blank">Aligning Or Relaxin Before Pregnancy?</a> Nutritious Movement. March 2011. </div>
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<a name="41">41</a>. Bowman K. <a href="https://nutritiousmovement.com/pregnancy-and-pain/" target="_blank">Pregnancy And Pain.</a> Nutritious Movement. December 2011. </div>
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<a name="42">42</a>. Bowman K. <a href="https://nutritiousmovement.com/natural-mama/" target="_blank">Natural Mama.</a> Nutritious Movement. January 2012. </div>
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<a name="43">43</a>. Gaskin IM. (2003). <a href="https://www.amazon.com/Ina-Mays-Guide-Childbirth-Gaskin/dp/0553381156/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=&dpID=51wXPOOPylL&preST=_SY344_BO1,204,203,200_QL70_&dpSrc=detail" target="_blank">Ina May’s Guide to Childbirth.</a> New York: Bantam Dell.</div>
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<a name="44">44</a>. Lawrence A, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24105444" target="_blank">Maternal positions and mobility during first stage labour.</a> Cochrane Database Syst Rev. 2013 Oct 9;(10):CD003934. </div>
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<a name="45">45</a>. Simkin P, Bolding A. <a href="https://www.ncbi.nlm.nih.gov/pubmed/15544978" target="_blank">Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.</a> J Midwifery Womens Health. 2004 Nov-Dec;49(6):489-504. </div>
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<a name="46">46</a>. Simkin PP, O’hara M. <a href="https://www.ncbi.nlm.nih.gov/pubmed/12011879" target="_blank">Nonpharmacologic relief of pain during labor: systematic reviews of five methods.</a> Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S131-59. </div>
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<a name="47">47</a>. Field T, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/9443139" target="_blank">Labor pain is reduced by massage therapy.</a> J Psychosom Obstet Gynaecol. 1997 Dec;18(4):286-91. </div>
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<a name="48">48</a>. Chaillet N, et al. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/24761801" target="_blank">Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis.</a> </span>Birth. 2<span style="font-kerning: none;">014 Jun;41(2):122-37. </span></div>
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<span style="font-kerning: none;"><a name="49">49</a>. Levett KM, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/27406639?dopt=Abstract" target="_blank">Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour.</a> BMJ Open. 2016 Jul 12;6(7):e010691. </span></div>
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<a name="50">50</a>. Shirvani MA, Ganji Z. <span style="font-kerning: none;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/24206010" target="_blank">The influence of cold pack on labour pain relief and birth outcomes: a randomised controlled trial.</a> J Clin Nurs. 2014 Sep;23(17-18):2473-9. </span></div>
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<span style="font-kerning: none;"><a name="51">51</a>. Ganji Z, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24403926" target="_blank">The effect of intermittent local heat and cold on labor pain and child birth outcome.</a> Iran J Nurs Midwifery Res. 2013 Jul;18(4):298-303. </span></div>
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<span style="font-kerning: none;"><a name="52">52</a>. Taavoni S, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/27502808" target="_blank">Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management.</a> Complement Ther Clin Pract. 2016 Aug;24:99-102. </span></div>
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<a name="53">53</a>. Taavnoi S, et al. <a href="https://www.ncbi.nlm.nih.gov/pubmed/21429078" target="_blank">Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial.</a> J Midwifery Womens Health. 2011 Mar-Apr;56(2):137-40. </div>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com13tag:blogger.com,1999:blog-801873645877244873.post-21905874100710704252017-07-16T09:10:00.000-04:002017-07-16T17:29:55.013-04:00Birth Wisdom<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
Until one experiences natural childbirth firsthand, there’s really no way to anticipate what it entails. You can do all the reading, all the watching, and all the listening to those who previously went through the gauntlet, but none of it truly captures the one-of-a-kind nature that is untamed birth. You have to simply go through it to really understand it.</div>
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Just shy of 3 years ago, my daughter Scarlet was born. It was a planned unmedicated home birth, which ended up in a hospital transport due to maternal exhaustion. Upon much reflection, there were a variety of lessons we drew from Scarlet’s birth (see <a href="http://zackhemsey.blogspot.com/2014/08/birth-lessons.html" target="_blank">here</a>) - lessons we fully intended to implement when it came time to have our second child. So when we conceived back in October of 2016, we felt like fighters training for a rematch. It would be entirely different this time around, and we would be ready to go the distance and then some, if necessary.</div>
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As before, Heather was focused on “preparing her vessel” prior to conception. This entailed optimal nutrition, exercise, sleep, etc, which continued throughout the entire pregnancy. Her diet was clean the first time around, but it was cleaner this time. She swam and aggressively walked while pregnant with Scarlet, but now she mixed in yoga and a whole lot of floor sitting, in order to maintain her hip flexibility and pelvic range of motion, which she knew would be critical during labor. Once more, she continued regularly seeing an acupuncturist, but this time she also consistently saw an osteopath, who was vital in maintaining a robust musculoskeletal structure and tendon / joint health all throughout the pregnancy - this in turn allowed Heather to maintain a higher level of activity than she would otherwise have been able to, evidenced by her attending yoga classes all the way into her 41st week of pregnancy.</div>
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Of course, having to take care of a toddler during pregnancy makes physical and mental preparation of any kind considerably more difficult to accomplish. But she did everything she could given the circumstances, which is all one can ever do. Funnily enough, in contrast to our first pregnancy, where we read everything we could get our hands on, with the second pregnancy we read little to almost nothing, because ultimately there is no better preparation than having actually lived through birth before. Plus, reading becomes untenable once tiny humans are running around and screeching all day long.</div>
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So we were ready to go, and on July 7th, 2017, four days past her “due date”, the time was upon us. After days of intermittent mild contractions, 9 AM brought a new variety. These required focus. Active labor had begun.</div>
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Thankfully, we had both slept for 7-8 hours, and that morning Heather ate like a champ while she had the capacity to do so. Both of these paid dividends down the line.</div>
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For the first 2-3 hours, we were on our own. Heather had opened up the windows and patio door, allowing a cool breeze to flow through the house along with the sound of the morning rain, which she found soothing as she labored on the floor of our dining room. During a contraction, I’d put extreme pressure on her sacrum which aided her ability to navigate the discomfort, while she vocalized and focused on her breathing. </div>
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Labor vocalization is definitely a distinct sound - it’s somewhere between a Tibetan chant and a dying animal - and it’s a little strange when one’s exposure to this sound inevitably ceases to be odd.</div>
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Eventually our doula and midwives arrived, joined shortly thereafter by Heather’s osteopath. Birth team fully assembled, the hard work continued. Any time her vocalizations started to creep up in tone, she was hit with constant reminders: “keep it low Heather”, “don’t tense up”, “stay relaxed”, “let it resonate downwards”, “let it in”, etc. </div>
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I moved the dining room table into the corner, and we set up a birthing pool in its place, allowing Heather to knock out the next couple of hours immersed in warm water, while the osteopath worked on Heather’s back and legs.</div>
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Then the party moved into our bedroom. Squatting on a small birth stool, Heather’s vocalizations reached a new level of intensity, and she started saying affirmations at the onset of each new wave of contractions - “my body and baby know how to birth” - after which she would lean backwards into my arms and go limp, while I massaged her lower back.</div>
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Time has a habit of skewing in labor (even for birth partners), so I don’t really know how long it was before the midwife explained that she was almost fully dilated at 9 cm. The caveat was that there was a small patch of cervix stubbornly hanging on, preventing the baby from moving downwards. Feeling wiped out, Heather opted to move to the bed for a momentary reprieve.</div>
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FYI, this was not just any bed - it was an organic bed that sat atop a hi tech frame, capable of independently moving the head and feet sections upwards. Put differently, it was a bed tailored for labor! And that is exactly what went through our minds when bed shopping the previous year - all things being equal, always go with the bed that will best facilitate a birth!</div>
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After a few rounds of contractions lying down, the midwife explained she could attempt to manually push back that last bit of cervix during the next contraction, if Heather wanted; otherwise, Heather should get back to being upright so as to let gravity better assist with the remaining inch of dilation. Unsure of how to proceed, and since she was already on the bed, Heather instructed the midwife to take a shot at the manual adjustment. And then she let out a blood curdling scream when that adjustment was attempted. Having failed to accomplish the goal, and feeling the sensation was entirely unnatural, Heather opted for plan B - back on the feet we would go, but not before her water finally broke in the midst of another contraction, an explosion that took everyone by surprise (as I suspect it probably often does).</div>
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Now on her feet, we made our way into the bathroom, where Heather sat on the toilet. The toilet may strike some as an odd birthing location, but it’s where people habitually go to relax their sphincter, and actually makes for a good labor site. At this point, Heather was beyond fatigued, and she was sort of swaying in front of me like a drunken sailor from utter exhaustion. She kept repeating, “I don’t think I can do this” … and we kept repeating, “yes you can - you’re already doing it”.</div>
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Sensing we were at a crucial precipice, where her focus and willpower could potentially get carried away from her, I asked the doula to trade places with me. Then I ran into the kitchen and grabbed an iPod off the counter that contained a playlist of music we had curated specifically for if / when we reached a point like this. Ear buds secure, I hit play - then she went totally silent for the next 10-15 minutes, breathing through the contractions without vocalizing. I could see her energy recharging, catching a second wind. It was fascinating to watch.</div>
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The midwives and doula then suggested that she get into the shower. After some initial protest, Heather begrudgingly relented. Ear buds removed, I assisted her into the shower. As soon as the water hit her body, she said it felt good and asked that we make it colder, which we obliged. And cold it got … like really fucking cold … like the kind of water polar bears approve of cold … like a shower that could offset climate change cold.</div>
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I was standing directly in front of her, as a leaning post, and when she had a contraction she would drop into a squat while I supported her underneath her arms. Cleverly, the midwives’ assistant gave me a towel to put around my neck for Heather to grab onto, and with which I could more efficiently support her.</div>
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After some amount of time in the shower, one of the midwives attempted to check her progress but was unable to get an accurate assessment, due to the confined space of the shower stall. So ironically, now to Heather’s great dismay, she begrudgingly got out of the shower and back into the open space of our bedroom.</div>
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The towel remained around my neck and shoulders, and we kept the same stand-squat routine going. As if in anticipation, the sun had by now reared its head outside, casting a beautiful shimmer over the trees, and it wasn’t long before the midwife proclaimed the cervix had fully receded and the head was descending. On we went. I suddenly realized that the midwife was directly behind me, on her hands and knees, in between my legs, checking the baby’s progress between Heather’s legs. It was like a game of Birth Twister.</div>
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Midwife: “Zack, please don’t sit on me”</div>
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Me: ”Susan, I would never sit on you”.</div>
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Heather: “Is that the head out?” </div>
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Midwife: “Yes it is!”</div>
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Heather: “Ok, is everyone ready?”</div>
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Birth Team: “Yes!”</div>
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The fog of labor was instantaneously lifted as the baby was birthed, preceded only by the warmest gush of fluid across my legs I have ever felt … like wonderfully warm … like water befitting a tropical desert paradise warm … like the kind of water those Japanese snow monkeys submerge themselves in to escape a merciless winter warm. Yes, I felt like a Japanese snow monkey on holiday. </div>
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As the baby was caught by the midwife between my legs, and handed upward between myself and Heather, I was jolted back to reality as the baby screeched, and I was perplexed at the extreme pale white appearance. “My God, she’s birthed a White Walker!” I thought to myself. As it turns out, it was just the vernix (which apparently was unusually plentiful for a full term baby). Soon thereafter, with vernix rubbed into the skin, the baby pinked up just fine.</div>
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And so it is with great delight that I introduce you to Willow Sky Hemsey:</div>
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In the aftermath of our first birth, I was surprised at some of the confusion (and borderline outrage) I received in response to what happened. Some felt our attempted home birth was irresponsible and dangerous, despite no one actually being in danger of anything at any point. Some felt it was masochistic to have an unmedicated birth and/or that we were trying to prove something (it wasn’t and we weren’t). Some felt we were exhibiting an unnecessary disdain or disregard for western medicine and/or technology (again, we weren’t). And some expressed incredulity that we would attempt another home birth after what had happened the first time, as if our birth with Scarlet was physically or mentally traumatic in nature (it wasn’t … it was crushing psychologically to not get the birth we had wanted, but it remained a positive experience on the whole, for both of us).</div>
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I found it bizarre (and still do) that so many completely miss the spirit of our actions. The desire to birth at home stems from a desire to birth naturally, unmedicated, in a familiar, comfortable, and safe environment. For us, that’s home. For you, it may be a hospital. In turn, the desire to birth naturally without medication stems from the physiological benefits of doing so, for both baby and mother (the reader can take it upon themselves to research this, or reference my response to the initial comment on <a href="http://zackhemsey.blogspot.com/2014/08/birth-lessons.html" target="_blank">Birth Lessons</a> where I go into greater depth). Importantly, being unmedicated prevents the natural birth process from being inadvertently undermined and short-circuited, for it maximizes the mother’s ability to coherently and effectively navigate birth, which then minimizes the potential need for interventions (and the domino effect of complications and further interventions that can often ensue as a result).</div>
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But there is an additional component to unmedicated natural childbirth that goes beyond the physiology, and it has nothing to do with pain or suffering. It’s about embracing the enormity of what the human body is designed to do, completely unfiltered and raw. It’s about surrendering to a process that evades our comprehension, without fear or anxiety. And it’s about feeling the connection between mother, baby, and body, and tapping into the extraordinary potential of the human psyche. It is uniquely transformative, capable of changing even those merely in proximity to it.</div>
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Of course, birth is not the only one-of-a-kind experience that exists. I imagine there’s probably nothing like free falling through the sky after jumping off a plane or mountaintop, or being in outer space, or climbing Mt Everest, etc. There is a diverse tapestry of rich and immensely powerful experiences humans are capable of encountering. But birth in its purest form may very well be the most challenging and exhilarating human event there is. It is riding a tidal wave toward the brink of your capacity, and then miraculously going beyond it. And it is a rite of passage for anyone wishing to come into direct contact with the essence of life itself.</div>
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When it was all over and done, Heather said the birth was the single greatest experience of her life. </div>
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My enduring thanks to the birth team: midwives Susan Schmidt and Cathy Gallagher; midwife assistant Nancy McDaid; doula Jen Pifer; and osteopath Karin Lipensky.</div>
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com9tag:blogger.com,1999:blog-801873645877244873.post-33503371054093182802017-05-07T10:22:00.000-04:002017-05-07T10:22:27.704-04:00The YouTube Red Checkmate<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
I’ve had many issues with YouTube’s Content ID System and the revenue (or lack thereof) that YouTube pays to content owners. Without rehashing all the details (which you can find <a href="http://zackhemsey.blogspot.com/2015/01/the-dark-side-of-youtube.html" target="_blank">here</a>, <a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html" target="_blank">here</a>, and <a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html" target="_blank">here</a>), the short story is that I was strong-armed into utilizing Content ID to monetize user-generated uploads containing my music, under what I perceive to be deplorably substandard deal terms (i.e. 55% of net revenue, with no clear understanding of what “net” constitutes). </div>
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While this compromise was necessary to combat unauthorized uploads of my music (and their illegal monetization of my content), when it came to my personal YouTube channel I elected not to monetize my own uploads with ads, in protest of the revenue splits that I find so distasteful (and in defiance of the emerging ad culture). So I wasn’t making money on my personal uploads, but neither was YouTube.</div>
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Then around the end of 2015, YouTube began unrolling something called YouTube Red. This was a new subscription based service that would allow subscribers to watch unlimited YouTube content without any accompanying or intrusive advertisements, in exchange for a flat monthly fee. It was touted as a new revenue stream for creators, who would be paid according to how much their content was watched by YouTube Red subscribers each month. Sounds good … you know, apart from receiving only 55% of net earnings within this new revenue stream.</div>
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Fast forward, YouTube Red is fully up and running in all territories, and Red income begins being collected on my behalf within the Content ID System. Then a realization eventually ensues. Shouldn’t I be receiving YouTube Red income for my personal uploads? After all, my YouTube channel is set up and approved for monetization (I simply disabled the ad option on all my videos). Let’s go take a look. Huh, I see there are YouTube Red views, but no YouTube Red money. What gives?</div>
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Well, it turns out that in order to receive my share of Red income for any given video, I am required to enable ads on that video. Even though these are two completely independent and unrelated revenue streams, YouTube holds Red earnings hostage until you agree to play the ad game. Of course, YouTube has not volunteered or acknowledged this fact, but it has been unequivocally established in practice (at least in my case). Basically, YouTube has designed an all or nothing monetization scheme - opt in and collect both ad and subscription revenue, or opt out and collect nothing.</div>
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Naturally, this introduces a new variable into the analysis. While foregoing ad revenue results in a lose-lose scenario, foregoing Red revenue results in a win-lose scenario, whereby YouTube pockets their share of Red revenue regardless of the fact that I have not received mine - my share of Red income just gets distributed to other content owners. So essentially, not participating in Red income equates to literally giving my money away to other people. </div>
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Thus, I now find myself in a situation where, in order to receive my share of YouTube Red earnings, I must monetize my YouTube channel with ads. Game, set, match. Well played YouTube. Well played.</div>
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com11tag:blogger.com,1999:blog-801873645877244873.post-19863102031410101622017-03-19T11:54:00.000-04:002018-02-25T11:07:19.418-05:00The Misunderstood Art Of Artistry<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
The term “artist” gets thrown around quite a lot. Nowadays, every creator seems to be a self-proclaimed artist, or is otherwise referred to as such by others. Well, appearances to the contrary, everyone is not an artist. Some are. Many aren’t. Moreover, a sizable portion of us don’t even seem to have an accurate conception of what artistry entails.</div>
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<span style="font-kerning: none;">The dictionary would have you believe that an artist is one who creates or performs art, or is habitually engaged or skilled in a creative practice. This is complete nonsense. I don’t know any genuine artist that would agree with this definition. While there is a logical simplicity to concluding that anyone who makes art is an artist, in actuality, the term “artist" is reserved for a specific type of individual that creates art. They are not simply writers, musicians, painters, dancers, etc…they are something that goes beyond the underlying mechanics involved, and beyond mere entertainment.</span><br />
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One of my pet peeves is when a judge on a show like American Idol asks a contestant, "What kind of artist do you want to be?” To ask this question, and to answer it, is to fundamentally misunderstand the term in question. You cannot choose what kind of artist you want to be. You simply are an artist, or you're not. This is to say, to be an artist is to have a specific mindset and psychology. The real question being asked here is “what kind of entertainer do you want to be?” This is an intelligible question, and one that can be answered.<br />
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<span style="font-kerning: none;">The misunderstanding of what an artist is, and the routine conflation between an artist and an entertainer, is now ubiquitous throughout the music industry and the general public. From a listener’s perspective, the distinction may be inconsequential, and using the terms synonymously provides a convenience within casual conversation. However, there is a danger in allowing the boundary between these classes to remain blurred, for in so doing we risk forgetting that they actually are two separate things, the substance of which matters. This is more than just semantics - because the motivation for why someone creates art influences the resulting art. As a creator, it is important to know who you are, and why you’re doing what you’re doing.</span></div>
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<span style="font-kerning: none;">An artist creates that which they are compelled to create. Their creation may or may not resonate with you. You may or may not enjoy it. It may or may not be what you would like to hear or see. But such is of no creative consequence to the artist. They are seeking to capture a vision; to express something that demands expression; to translate feelings or ideas in a way that is inherently self-satisfying.</span></div>
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<span style="font-kerning: none;">An entertainer, on the other hand, creates that which they think you will like. They are creatively concerned with the opinions of others, and seek to mold their creation in accordance with outside expectations and/or predicted reactions. This type of individual is often popularly referred to as a "commercial artist”, though this is an inadequate characterization, as will become clear.</span></div>
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<span style="font-kerning: none;">Artists are human beings of course, and few enjoy having their work (or themselves) criticized or ridiculed. But while an artist may hope their work resonates with you, and be intensely disappointed if it doesn’t, ultimately outside praise or lack thereof has no impact on the merits of their efforts. The opposite holds true with entertainers, as their legitimacy lives or dies based on outside opinion - if the audience is not engaged, their efforts have been in vain.</span></div>
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<span style="font-kerning: none;">One might be tempted to conclude from these descriptions that I am insinuating artists are superior to entertainers. This is not so! They serve different functions and the world benefits from both</span><span style="font-family: Helvetica;">.</span><span style="font-family: Helvetica;"> </span><br />
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<span style="font-family: Helvetica;">One might also confuse a discussion about creators with that of their resulting </span><span style="font-family: Helvetica;">creations.</span><span style="font-family: Helvetica;"> </span><span style="font-family: Helvetica;">To be clear, we’re discussing the former, not the latter.</span><span style="font-family: Helvetica;"> </span><span style="font-family: Helvetica;">So we don’t need to debate whether the byproduct of a creator is or isn’t art, or if it’s good or bad, etc. Those are subjective determinations that will vary from person to person. But whether the creator is an artist is not subjective. T</span>hat is a fact. It may be a fact we are not privy to, or one that we suspect but can’t be certain of, but there is no debating that every creator has a set of intentions and motivations, whatever they may be. And I contend there is merit to unpacking these, both as consumers and creators - for it fosters clearer conceptions of what artistry entails, which ultimately serves to enhance both the creation of art and our appreciation for it.</div>
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<span style="font-kerning: none;">With all of that said, there is some additional nuance and confusion to the artist / entertainer analysis, which I will now address.</span></div>
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<span style="font-kerning: none;">Let’s start with money. Both artists and entertainers can seek to make money from their art. However, money will not factor into the artistic process of the artist - if it is considered at all, it will be an afterthought, with no actual creative influence. In contrast, the entertainer can be (and often is) motivated to create art specifically in order to make money, wherein creative decisions are designed to ensure and/or maximize appeal and profitability. So the monetization of art in and of itself is not sufficiently revealing - it’s whether monetization plays a causal role within the art’s creation. There is nothing wrong with creating art for the purpose of financial gain, but such a person is not an artist.</span></div>
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<span style="font-kerning: none;">With respect to a “commercial artist”, this is an acceptable and coherent designation only if a genuine artist is making a living off of their art. Culturally, it often involves a pejorative connotation, in which a commercial artist is not seen as a true artist, or one that has "sold out", etc. But this connotation is really a misplaced reaction to the common merging of artists and entertainers as being one and the same - once you parse out that confusion, there is a perfectly respectable place for a commercial artist to exist. On the flip-side, it makes absolutely no sense to ever refer to an entertainer as a commercial artist - they are certainly commercial, but certainly not artists.</span></div>
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<span style="font-kerning: none;">Next up, fans. Artists and entertainers can both perform their music for fans, and take sincere pleasure, fulfillment, and inspiration from the impact their music has on other people. However, if you’re making music <i>for</i> your fans, then you are not an artist…you’re an entertainer. The same applies if you make creative decisions based on what your fans want to hear (or what you think they want to hear). There is nothing wrong with catering one's art to meet with outside expectations…but such disqualifies you as being an artist.</span></div>
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<span style="font-kerning: none;">Sometimes performers or musicians get referred to as artists (e.g. “he is a true artist with that violin”), but this is a different usage of the term. While there certainly is an awe-inspiring mastery involved in compelling musicianship and performing, this is not the same thing as being an artist. As breathtakingly skilled and uniquely expressive as they may be, performers and musicians are interpreting art; not creating it. The world needs these people, without question - it’s simply inaccurate to label them artists.</span></div>
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<span style="font-kerning: none;">Being an artist doesn’t mean you can’t be influenced by the art of others. We live in an interconnected world, and nothing (including you) exists in pure isolation. But an artist does not attempt to be or sound like anything other than who they are. Artists take inspiration from others; entertainers imitate others. While some say imitation is the greatest from of flattery, to an artist, such is a wasted opportunity for authentic self-expression. Celebrate and revere your idols and influences…but if you’re trying to become them, you are not an artist.</span></div>
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<span style="font-kerning: none;">Being an artist also doesn’t prevent you from taking the advice of others, or implementing outside suggestions…so long as you genuinely find such suggestions artistically compelling. Of course, many an artist work in isolation, but plenty have sought input from others which they have taken into creative consideration. Now, if you make changes based on the opinions of others, despite not artistically agreeing with them, well then you have quite obviously compromised your artistry. This doesn’t make you a bad person, it’s just the fact of the matter.</span></div>
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<span style="font-kerning: none;">Furthermore, being an artist doesn’t prevent you from enlisting the assistance of others (e.g. utilizing skilled experts, such as musicians, mixing or mastering engineers, etc)…so long as you remain in creative control and tied to the process. That being said, if you’re outsourcing all of the composing and songwriting, there’s obviously nothing left in which your artistry can subsist - in that case, you are a performer, or possibly even an entertainment brand. You might be popularly referred to as a “recording artist”, but as with “commercial artist” discussed above, such a designation can only be applied to an actual artist that records their own music - if you’re recording the music of others, you’re clearly not an artist.</span></div>
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<span style="font-kerning: none;">Is being a true artist mutually exclusive with collaboration? The answer depends on what the motivation is for collaborating. If you’re doing it to gain new fans via cross-promotion, maintain relevancy, etc, then you’re functioning as a promoter and entertainer. If you share a creative vision with someone, or are compelled to explore where a collaboration will lead, then you are functioning as an artist (despite potentially having to compromise on various creative decisions / executions therein).</span></div>
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<span style="font-kerning: none;">In addition, an artist can experiment with methods, styles, instrumentation, collaboration, etc that might not deeply appeal to them, for the purposes of learning and discovery; but an artist would never release anything that was not truly representative of them. So exploration in and of itself is not a disqualification of artistry. I might be curious about jazz music and begin experimenting with the genre. It might prove interesting in various ways; I might learn a lot; I might be creative in how I navigate the tonal landscape; but if my efforts to make a jazz album are not based on an authentic connection to the music, then I am not being an artist. Having said that, I might ultimately stumble upon something that keeps me glued to the process; some aspect of jazz that surprisingly won’t let go, and which compels me to go further - in that case, such will have become an artistic endeavor. </span></div>
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<span style="font-kerning: none;">Then there is the matter of work-for-hire composers and writers. Are these individuals artists? If you are creating, modifying, or tempering your work in order to satisfy someone else (e.g. director, producer, etc), or for the benefit of your resume, or to expand your network, or for the paycheck, etc, then obviously you are not an artist (you’re essentially a craftsman). However, to the extent that a work-for-hire creator is genuinely collaborating with their employer(s), or is given free reign to do as they see fit, and the nature of the content truly resonates with them, then they are absolutely functioning as an artist. Even though many work-for-hire endeavors are in response to someone else’s vision (e.g. a brief, film, screenplay, etc), such doesn’t automatically negate legitimate artistry, for it is really no different than responding to any other outside stimulus, event, or experience in one’s life, and it doesn’t matter where artistic inspiration originates. That being said, if you’re working on something that you honestly don’t give a shit about, then regardless of how creative you may be, your efforts have nothing to do with artistry.</span></div>
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<span style="font-kerning: none;">Lastly, there is the question of whether it’s possible to be both an artist and an entertainer. With respect to the creation of art, the answer is NO! Having said that, an artist can certainly parallel the behavior of an entertainer after the creative process concludes (e.g. touring / performing for fans and money, engaging in promotion, etc). An artist might also consciously step into the role of an entertainer or craftsman, in order to make ends meet financially. Similarly, an entertainer might stumble upon a song that really speaks to them, and which they pursue artistically, in contrast to their normal affairs. In other words, a person might travel back and forth between both domains, but at any given creative point, you can only exist in one or the other. There is no artist-entertainer continuum, and there are no degrees of artistry - you’re all in, or all out.</span><br />
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In summary, one’s identity as an artist fundamentally turns on the nature of their creative process - what are they seeking to accomplish, and why? If you are creating art as a means to an end, you are not an artist. If you are creating art because you are compelled to do so, solely as an end unto itself, then you are. This principle can be broadly applied to any activity or enterprise. It is what separates a chef from a cook; a martial artist from a prizefighter; etc. It’s also worth reiterating that every facet of the arts has its place. Artists, entertainers, craftsman, musicians, performers - they all play a role in enriching the human experience. Being an artist doesn’t make you more important - but the importance of artistry cannot be overstated. So if you happen to be among those infused with artistic spirit, I implore you to stay true to that spirit. You can’t choose to be an artist - artistry chooses you - but you can choose whether or not to honor it. For those in the position to do so, I sincerely hope you will.<span style="font-kerning: none;"></span><br />
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com68tag:blogger.com,1999:blog-801873645877244873.post-55980890721995026832016-05-04T08:58:00.000-04:002016-05-04T15:38:05.586-04:00When It Comes to YouTube, Google Is Only Half The Problem…The Other Half Is Major Labels And Publishers<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
It is common knowledge that the creative community has been discontent with YouTube for some time. In recent weeks, a variety of articles have surfaced featuring various members of the music industry as they decry the paltry payouts issued by the streaming giant.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote1"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#1">1-5</a></sup> This outrage is not without merit, for despite YouTube being the largest music streaming platform (in terms of both content and users), it is also the lowest paying.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote6"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#6">6-9</a></sup> These substandard payouts stem from the price of YouTube ad space, along with the revenue splits employed by YouTube in distributing ad revenue. Indeed, the latter is the bigger issue, as YouTube pays content providers a mere 55% of net earnings.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote10"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#10">10-12</a></sup></div>
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It is unclear exactly how much YouTube takes off the top before splitting the remaining ad revenue, but it has been reported that this figure is 10%.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote13"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#13">13</a></sup> Of course, without the ability to audit the company, it’s impossible to verify this with certainty, but if true, it means that YouTube is paying artists (and all content owners) 49.5% of the gross ad revenue.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote14"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#14">14</a></sup> Importantly, when it comes to monetizing user-generated content, this percentage gets further reduced for the many artists who are dependent upon intermediary Content ID service provides that take commission on the content owner’s side of the earnings - for this group, payouts drop even further, typically between 37-42% of the total pie.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote15"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#15">15</a></sup></div>
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Now, depending on the artist, there may or may not be labels, publishers, managers, etc with their hands in the pot on the artist side of earnings; but the literal amount that ends up in an artist's pocket is irrelevant from the standpoint of how big (or small) the artist pot is to begin with. It’s one thing to assess a platform in terms of the revenue it generates, and another thing to assess the fairness of how that revenue gets divided. Consider that iTunes, which has become the unofficial benchmark of revenue splits, pays 70% of gross earnings to the artist.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote16"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#16">16</a></sup> Spotify does the same.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote17"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#17">17</a></sup> Apple Music pays 71.5-73% of gross.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote18"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#18">18</a></sup> And other services, such as Bandcamp, pay as much as 90% of gross to the artist.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote19"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#19">19</a></sup> That is a substantial difference in comparison to YouTube, with important financial consequences. </div>
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Google asserts that such comparisons are misguided,<sup style="font-size: 9px; line-height: 8px;"><a name="footnote20"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#20">20</a></sup> as download services and paid subscription streaming services are structurally different than a free ad-supported framework - instead, they argue YouTube is more akin to traditional radio. Well, last time I checked you couldn’t turn on the radio and choose the songs you want to hear. In contrast, YouTube is an interactive on-demand service…it may be different from other on-demand streaming platforms, but not in a way that justifies paying 55% of net revenues to creators.</div>
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So, how has YouTube managed to successfully implement an obviously unfair and exploitative system? There are a few variables involved, three of which I will briefly summarize.</div>
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First, YouTube is able to facilitate the uploading of unauthorized user-generated content, while being legally protected under the “safe harbor” provision of copyright law. In short, anyone can upload anything they want, and YouTube is not liable for their actions.</div>
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Second, the DMCA process, whereby a copyright owner can notify YouTube of an unauthorized video containing their work, with instructions for it to be taken down, is severely flawed in a variety of ways, ultimately making it useless as a method of keeping content off of the platform.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote21"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#21">21</a></sup></div>
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Third, access to YouTube’s audio recognition Content ID System, which thoroughly addresses the above by identifying user-generated content on an automated and ongoing basis, is granted by YouTube only at their discretion.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote13"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#13">13,21</a></sup> Accordingly, they have elected to grant access to just a subset of content owners, access which is conditioned upon consenting to the terms of Google’s label and/or publishing agreement.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote4"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#4">4,21,22</a></sup> Essentially, Google leverages the value of Content ID to strong-arm parties into accepting what are widely held to be substandard deal terms. For those denied access to Content ID (a substantial portion of applicants), and for those that refuse to consent to Google’s label / publishing deal, the only recourse is to engage one of a variety of independent services that will broker Content ID access in exchange for their ability to monetize your work.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote12"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#12">12,21</a></sup></div>
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The upshot of these 3 variables is that it is impossible for copyright owners without direct access to Content ID to remove their content from YouTube. And for those with direct access, they have begrudgingly accepted YouTube’s monetization terms in order to gain that access. Consequently, the music industry has been stripped of negotiating power with respect to securing more equitable compensation from the platform. It is a strategy part divide and conquer, and part blackmail - you can accept YouTube’s payout rates and make some money from user-generated content with Content ID access…or you can reject them and earn nothing, with no access to Content ID (in which case your content will often end up being monetized by others without your consent or participation).<sup style="font-size: 9px; line-height: 8px;"><a name="footnote21"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#21">21</a></sup></div>
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But there is a 4th variable, one which is just as important as the others, but which rarely (if ever) gets discussed. While only a subset of content owners have direct access to Content ID, that subset is inclusive of the largest media companies - companies that include major record labels and publishers. Even though YouTube succeeded in leveraging Content ID and the inefficiencies of DMCA to compel these companies into entering unfavorable licensing deals, those deals do not obligate said parties to monetize the content in question. In fact, the “majors” are free to utilize Content ID in whatever manner they wish - monetize, track without monetization, or block all user-generated content. Thus the majors, whose catalogs presumably account for the majority of music streaming on YouTube, possess the ability to effectively pull their catalogs from YouTube with the click of a mouse. And make no mistake, a system wide Content ID block by the majors would create sizable ripples, changing the landscape of music streaming for all parties, major and non-major alike. So why haven’t they? Because they are pussies. No seriously, they really are pussies.</div>
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Many of the music industry representatives complaining about YouTube’s low payouts in the press are the same people that are in a position to cut their ties - but instead of actually doing that, they choose to continue taking it up the ass from Google. Now, don’t get me wrong, if someone wants to take it up the ass, that’s their prerogative. But you can’t choose to take it up the ass and then start complaining about how your ass is all sore.</div>
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If you’re like me, you are perplexed by this behavior. Surely the labels / publishers are comprised of intelligent individuals that see the absurdity of the current situation. Even Google has publicly pointed out the obvious, stating in response to claims that YouTube unfairly devalues music: “Thanks to Content ID, record labels…can remove any or all user-uploads of their works from the platform on an automated and ongoing basis”.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote1"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#1">1</a></sup> While this conveniently leaves out the fact that not all content owners have direct access to Content ID, their statement is 100% accurate as it pertains to major labels and publishers. Moreover, the failure of labels / publishers to utilize Content ID to remove all of their material, or to at least cease all YouTube monetization of both direct uploads and user-generated content, renders them complicit in the exploitation that transpires, and it serves to reinforce and reward such behavior by Google.</div>
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So, why is the music industry continuing to monetize their content on YouTube when they object to what they’re being paid? I can only speculate. Maybe they are afraid of making Google angry. Or maybe the people calling the shots at these labels / publishers have hidden loyalties to Google, while everyone else is unaware or powerless to stop the coup. More than likely though, I suspect the real reason is that although they are unhappy with the revenue splits in principle, the amount of money being made is still substantial, despite being a fraction of what it should be…I think they simply can’t bring themselves to leave the money on the table and walk away. But of course, that is precisely what’s required to get Google to the negotiating table. You have to be prepared to endure financial sacrifice. You have to have a spine. You have to be willing to not be the bitch of a corporate behemoth.</div>
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Easier said than done, it would seem. To be clear, I acknowledge that it can be difficult to walk away from sizable sums of money. How much would you be willing to walk away from, for the sake of principle? $10,000? $100,000? $1,000,000? Many probably wouldn’t be willing to walk from any of these sums. I get it. After all, I am currently receiving YouTube monetization income, via indirect Content ID access.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote12"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#12">12</a></sup> As much as I detest the conditions and circumstances that led to me receiving this supplemental income stream, I don’t detest having more money in and of itself. Who can’t use extra money?</div>
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But at the end of the day, if you don’t want to be exploited and taken advantage of, you need to stop allowing yourself to be exploited and taken advantage of. It’s pretty straightforward. And the reality is that we’re not talking about a poverty stricken class facing a financial dilemma…we’re talking about major label artists and bands. If Taylor Swift is making 5 million dollars in YouTube ad revenue, she’s making hundreds of millions elsewhere. This is to say, it’s all relative and any potential ad income from YouTube is indicative of much greater revenue outside of YouTube. They can afford to leave the money on the table. And remember, for every dollar paid out to the music industry (reportedly $2-3 billion to date),<sup style="font-size: 9px; line-height: 8px;"><a name="footnote1"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#1">1,23</a></sup> YouTube retains an equal or greater sum; if there’s one thing that corporations deplore, it’s losing billions of dollars of revenue.</div>
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Now, I will grant you that it is convenient for me, one who does not have direct access to Content ID and therefore can’t lead by example, to argue that other people should cease YouTube monetization for the greater good. But note that not one of the 34 million views to date on my personal YouTube channel is or has been monetized by me. I assure you, if tomorrow I were granted direct access to Content ID, I would not hesitate to cease monetization of the now 209,000 user-generated videos that have been identified and their resulting 33 million average monthly Content ID views. Why? Not because I don’t want or can’t use the money, but because fuck you if you think I’m accepting 55% of net proceeds.</div>
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It’s worth considering too that in all likelihood, a system wide Content ID block by the majors would lead to increased traffic on other paid streaming platforms, all of which pay more than YouTube. Of course, Google claims<sup style="font-size: 9px; line-height: 8px;"><a name="footnote2"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#2">2,4</a></sup> that YouTube is monetizing a substantial portion of music consumers who otherwise would not be willing to pay for music…but even if this is true, it just means that many of these consumers will find a different free streaming service, such as Spotify, whose free ad-supported tier payouts, while also controversial, are still higher than YouTube. And sure, perhaps some of these consumers will end up resorting to piracy, or utilizing a non-paying streaming service, or simply consuming less music - so what? What’s the alternative, to continue getting exploited indefinitely while lining the pockets of Google? But let’s not forget the other possibility, that a system wide Content ID block ends up leading to a renegotiated and more equitable distribution of YouTube ad revenue…imagine that.</div>
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Of course, even if YouTube were to increase revenue splits comparable to its competitors, giving a minimum of 70% of gross earnings to artists, it may still remain the lowest paying music company with respect to the actual payments it disperses. But that, in and of itself, is not the real issue at hand - after all, any comparison of this kind will always yield a hierarchy - someone has to be on the bottom. Drawing conclusions based on total or individual payouts is highly misleading. It’s about how revenue gets distributed, and the freedom (or lack thereof) on the part of creators to participate. Thus, artists and music reps pointing to per stream rates, or earnings per X number of views, is a misguided approach. Similarly, Google praising itself for having paid $3 billion to the music industry to date completely misses the point. The exploitative nature of the exchange that led to that $3 billion is the issue at hand. And while the overall amount that YouTube pays may be growing with every year,<sup style="font-size: 9px; line-height: 8px;"><a name="footnote20"><a href="http://zackhemsey.blogspot.com/2016/05/when-it-comes-to-youtube-google-is-only-half-the-problem.html#20">20</a></sup> unless you fix the underlying inequity inherent in the formulation of those payments, you will only be compounding that exploitation. So a more equitable revenue split will not only narrow the gap between YouTube and competing services, but it will also shift focus to the proper value of YouTube as a promotional and advertising space.</div>
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To that end, one could argue that user videos that contain music in the background (e.g. cat videos, sports videos, etc) constitute a partially new and unique revenue source. At the same time, one could argue that music-specific YouTube videos cannibalize income from higher paying competing services. Then there are the myriad variables that go into how ad payments are calculated per view, one of which is geography (e.g. a view in the United States is worth more than a view in Spain). All of this complicates straightforward comparisons between YouTube and other platforms, but the bottom line is that if creators choose to participate in the service, they should reap a fair percentage of revenue from that participation. I’m not, and I don’t think anyone is, anti-YouTube in principle…I’m simply against being forced to participate while being monetarily exploited.</div>
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I do concede that it’s within the realm of possibility that Google could react to a music industry revolt by revoking all direct Content ID access. But such an action by Google would escalate the conflict, serving to greatly strengthen the legal argument and current lobbying efforts to rework the existing DMCA and safe harbor provisions. The fact is that Content ID is the best defense that Google has in maintaining the status quo - to take that away from the majors would be to potentially shoot themselves in the foot, and it goes without saying that a successful DMCA “take down and stay down” revision would take considerable wind out of YouTube’s sails.</div>
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I will also concede that perhaps major labels and publishers began their partnership with YouTube in good faith that initial unfavorable terms would improve over time. But even if that was the case, the ship has long since sailed. What you have now is not going to change, for there is no incentive on Google’s part to do so…at the end of the day, despite stamping their feet in protest, the music industry is complying with what Google wants it to do.</div>
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And just to be clear, DMCA and safe harbor are most certainly in need of a serious overhaul - they can, and should, immediately be revised to properly apply within the current context of digital consumption. This is particularly all the more pressing if YouTube is going to continue withholding direct Content ID access to so many content owners, therein stripping away their ability to abstain from the platform. But this has no bearing on the fact that the largest sectors of the music industry already have the capacity to effectively and efficiently withdraw their catalogs via direct Content ID access - and there is no greater negotiating power than that.</div>
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So majors, you have a choice to make. You can continue to do what daddy Google tells you to do, or you can grow a pair and have some dignity. If you choose the former, so be it, but please shut the fuck up about your discontent moving forward…you have become the battered wife that refuses to leave her abusive husband, and it’s depressing to witness. So right after you finish chastising Google for being evil, do us all a favor and stop being a bunch of pussies.</div>
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<a name="1"><b>1 </b></a><a href="http://recode.net/2016/04/11/youtube-google-dmca-riaa-cary-sherman/">"Here's why the music labels are furious at YouTube. Again."</a> Re/Code. April 11, 2016.
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<a name="2"><b>2 </b></a><a href="http://www.theregister.co.uk/2016/04/19/ansip_tells_youtube_cough_up_royalties/">"Europe's divi-boss tells YouTube to cough up proper music royalties"</a>. The Register. April 19, 2016.
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<a name="3"><b>3 </b></a><a href="http://www.theguardian.com/music/musicblog/2016/apr/26/debbie-harry-youtube-royalties">"Debbie Harry: "Music matters. YouTube should pay musicians fairly"</a>. The Guardian. April 26, 2016.
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<a name="4"><b>4 </b></a><a href="http://www.theguardian.com/music/2016/apr/25/nikki-sixx-youtube-music-royalties">"Nikki Sixx launches campaign to get YouTube to 'do the right thing' over music royalties"</a>. The Guardian. April 24, 2016.
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<a name="5"><b>5 </b></a><a href="http://www.theguardian.com/music/musicblog/2016/may/02/nelly-furtado-youtube-artist-royalties-fair-pay">"Nelly Furtado: "YouTube pays more than nothing. That doesn't make it fair"</a>. The Guardian. May 2, 2016.
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<a name="6"><b>6 </b></a><a href="http://www.fastcodesign.com/3048607/what-major-music-streaming-services-pay-artists-visualized">"What Major Music Streaming Services Pay Artists, Visualized"</a>. Co.Design. July 15, 2015.
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<a name="7"><b>7 </b></a><a href="http://www.digitalmusicnews.com/2015/09/14/youtube-music-is-growing-60-faster-than-all-other-streaming-music-services-combined/">"YouTube Music Is Growing 60% Faster Than All Other Streaming Music Services Combined"</a>. Digital Music News. September 14, 2015.
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<a name="8"><b>8 </b></a><a href="http://blog.sonicbids.com/how-much-do-the-most-popular-streaming-services-pay-per-stream">"How Much Do the Most Popular Streaming Services Pay Per Stream"</a>. Sonicbids Blog. July 20, 2015.
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<a name="9"><b>9 </b></a><a href="http://www.techtimes.com/articles/66603/20150708/youtube-not-spotify-pandora-or-apple-music-is-the-number-one-music-streaming-service-worldwide-here-s-why.htm">"YouTube - Not Spotify, Pandora Or Apple Music - Is The Number One Music Streaming Service Worldwide: Here's Why"</a>. Tech Times. July 8, 2015.
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<a name="10"><b>10 </b></a><a href="http://adage.com/article/digital/youtube-tv-sweetheart-ad-deals/245019/">"YouTube to Tv Networks: No More 'Sweetheart' Ad Deals for You!"</a> Ad Age. October 31, 2013.
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<a name="11"><b>11 </b></a><a href="http://www.jankysmooth.com/how-youtube-pays-artists-by-east-bay-ray-12-02-2015/">"How YouTube Pays Artists by East Bay Ray"</a>. Janky Smooth. December 3, 2015.
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<a name="12"><b>12 </b></a><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html">"Shining Some Light On The Dark Side Of YouTube"</a>. Zack Hemsey Official Blog. January 28, 2016.
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<a name="13"><b>13 </b></a><a href="http://musictech.solutions/2016/03/20/youtube-revenues-explainer/">"YouTube Revenue Explainer"</a>. Music Tech Solutions. March 10, 2016.
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<a name="14"><b>14 </b></a>10% off the top means content owners would be getting 55% of the remaining 90% of revenue, which equates as follows: .55 X .9 = .495 (49.5%).
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<a name="15"><b>15 </b></a>Assuming a commission of between 15-25% on the artist portion of earnings (49.5% in this scenario), this would leave the artist with 75-85% of their original share: .85 X .495 = .42075 (42%) / .75 X .495 = .37125 (37%).
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<a name="16"><b>16 </b></a><a href="http://www.tunecore.com/index/sell_your_music_on_itunes">"Sell Your Music on iTunes"</a>. Tunecore Official Website.
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<a name="17"><b>17 </b></a><a href="http://www.spotifyartists.com/spotify-explained/#how-we-pay-royalties-overview">"How we pay royalties: an overview"</a>. Spotify Official Website.
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<a name="18"><b>18 </b></a><a href="http://www.businessinsider.com/apple-is-going-to-start-paying-artists-per-stream-after-launch-2015-6?r=UK&IR=T">"Here's how much Apple Music is going to pay artists"</a>. Business Insider. June 22, 2015.
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<a name="19"><b>19 </b></a><a href="https://bandcamp.com/pricing">"Pricing"</a>. Bandcamp Official Website.
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<a name="20"><b>20 </b></a><a href="http://www.theguardian.com/music/musicblog/2016/apr/28/youtube-no-other-platform-gives-as-much-money-back-to-creators">"No other platform gives as much money back to creators"</a>. The Guardian. April 28, 2016.
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<a name="21"><b>21 </b></a><a href="http://zackhemsey.blogspot.com/2015/01/the-dark-side-of-youtube.html">"The Dark Side Of YouTube"</a>. Zack Hemsey Official Blog. January 28, 2015.
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<a name="22"><b>22 </b></a><a href="http://zoekeating.tumblr.com/post/108898194009/what-should-i-do-about-youtube">"What should I do about YouTube?"</a> Official Zoe Keating Blog. January 22, 2015.
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<a name="23"><b>23 </b></a><a href="http://www.musicbusinessworldwide.com/youtube-says-paid-2bn-music-rightsholders-really-mean/">"YOUTUBE SAYS IT'S PAID $2BN TO MUSIC RIGHTSHOLDERS. BUT WHAT DOES THAT REALLY MEAN?"</a> Music Business Worldwide. October 26, 2015.Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com10tag:blogger.com,1999:blog-801873645877244873.post-55459527715024567572016-04-23T11:46:00.000-04:002016-04-23T11:47:19.061-04:00Prim’s Cat: The Real Mockingjay?<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
Last night I watched <i>The Hunger Games: Mockingjay - Part 1</i>. Am I the only one who was scratching their head at the sheer ridiculousness that was exhibited? Not with respect to the dystopian future portrayed. Not with respect to blowing up planes with exploding arrows, while the archer remains unscathed despite standing directly in the path of the aircraft’s machine gun fire. I’m fine with all of that. What I cannot get on board with is the behavior exhibited by Prim’s cat. Let’s walk through the events that unfolded.<br />
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Katniss visits what remains of District 12, where she discovers her sister’s cat within the family’s former residence. She then picks up and places the cat inside her satchel bag, as she peruses the house for other items to salvage, at one point opening the bag and tossing a picture frame in alongside the cat. All things (and cat) in bag, she returns to District 13 (presumably by air since that is how she got to District 12 in the first place), makes her way through the compound to find her mother and sister, opens up the bag, and out comes the cat…a cat who has been shockingly indifferent to hanging out in a bag during the tumultuous journey over land and air.</div>
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At this point I turned to my wife and said, “this movie has lost all credibility”.</div>
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Ok, well maybe this cat hangs out in satchel bags devoid of breathable mesh screens all the time. Maybe he spent his adolescent years at a military base where he was a frequent flyer. And maybe he’s got an extremely serene disposition to top it all off.</div>
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But alas, the plot thickened. Later in the film, residents of District 13 are rushed into an underground bunker to take shelter from an impending airstrike from the Capitol. However, the bombing commences before Prim makes it into the bunker - you see, she had gone to retrieve her cat and is now racing down the stairs with the animal in her arms, in the midst of explosions, falling debris, and cascading water spewing from what I assume was a sprinkler system set off by the bombing. At the last moment, they make it into the bunker in one piece, as the cat continues to hang out in Prim’s arms without ever having squirmed an inch; wet and seemingly content with the entire ordeal.</div>
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Now, I ask you, what kind of mystical fucking cat is this? Unless the cat’s actually a robot, this is either the most relaxed cat in the history of the feline species, or the movie decided to cut out the part where the cat gets injected with Valium. Or the movie was produced by dog owners who have no experience with cats and are strangely under the assumption that they are meditative beings capable of achieving extraordinary levels of zen. </div>
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Regardless of how the cat came to be portrayed in this manner, rest assured - I don’t care how awesome that cat is (and I’ve known some pretty awesome cats in my day), Prim’s arms, body, and/or face should have been cut up and bleeding from the clawing that would have transpired as that cat lost its fucking nerve. Merely managing to hold onto the cat at all during that fiasco would have been miraculous. To do so and remain unscathed…perhaps the single greatest feat of all time. To have the cat stay as calm as a summer afternoon nap throughout it all…fucking impossible. The movie should have just made Prim a sorceress, as a magic spell would have been more believable than what was depicted.</div>
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But in case you thought that was the last of the cat, fear not, for at the end of <i>The Hunger Games: Mockingjay - Part 2</i>, he makes one more appearance. By now, days or weeks have elapsed since the bombing of District 13, a war has been waged, and many have perished. Katniss is now back in District 12, trying to make sense of the chaos that has led her to this point, when lo and behold, the cat appears in the window. He has traveled untold miles, through battlefields and ruins, persevered against bombings and starvation, and has finally made it back home. In response to the cat’s truly heroic efforts, Katniss goes completely psychotic, unleashing all of her pent up anger onto the cat who has unknowingly become the symbol of everything she lost. The screams escalate into attempted battery, as Katniss throws a glass across the kitchen with the intention of stoning the cat, all in a furiously loud and violent rage as she aggressively moves closer toward the cat…a cat who remains stoically silent and still in response. He doesn’t run away; he doesn’t hiss; he doesn’t even flinch when the glass flies within inches of his face, smashing into shards upon contact with the countertop and backsplash…he just looks at Katniss, as if to say, “Katniss - I know - it’s not your fault”.</div>
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Wow.</div>
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My wife turned to me and said, “that cat would never have sat there like that”. To which I replied, “are you kidding me, if that cat did anything other than sit there, the movie would have been totally inconsistent”.</div>
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com7tag:blogger.com,1999:blog-801873645877244873.post-66714342301968649562016-01-28T12:28:00.001-05:002016-04-12T17:28:45.432-04:00Shining Some Light On The Dark Side Of YouTube<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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Not too long ago, I wrote about my frustrations with YouTube - a platform that enables unauthorized uploads of copyrighted content (commonly referred to as “user generated content”, or UGC) - uploads that are often illegally monetized, as facilitated by YouTube, and the revenue of which YouTube shares and participates in. <br />
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<span style="font-family: Helvetica;">There is also the matter of YouTube’s Content ID System - a digital audio fingerprinting system that is a necessary tool for copyright owners to police UGC, but a system that YouTube selectively allows access to (access which I was denied for reasons unknown), thus creating the ability of those with access to fraudulently utilize Content ID to illegally claim and monetize the content of those without access (with no mechanism in place for the rightful copyright owner to notify YouTube of the fraudulence in question or properly dispute it).</span></div>
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And then of course there’s the matter of YouTube, along with uploaders of illegally monetized UGC and parties misusing Content ID, keeping all the money that was earned as a result of the illegal monetization of copyrighted content.</div>
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I was repeatedly falling victim to the above (as detailed <a href="http://zackhemsey.blogspot.com/2015/01/the-dark-side-of-youtube.html" target="_blank">here</a>), so I had a decision to make. I could do nothing and let the anarchy continue. Or I could engage an intermediary service to gain indirect access to the Content ID System. While YouTube is extremely selective in granting copyright owners direct access to Content ID, there are a variety of independent companies with direct access, which broker indirect access to the common man. As far as YouTube is concerned, anyone is free to deal with such “Content ID brokers”.</div>
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It is important to note that intermediary Content ID brokers all require monetization of UGC, for which they take a commission on the resulting ad revenue. In this way, YouTube basically forces the hand of a copyright owner - join us (indirectly) and monetize, or otherwise let us get back to monetizing your shit without your involvement.</div>
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After considerable internal debate, I decided that as much as I dislike the online ad culture, I hate people hijacking and illegally monetizing my content far more. Plus, I reasoned I could keep my <a href="https://www.youtube.com/user/ZackHemsey" target="_blank">official YouTube channel</a> ad free, while only monetizing UGC - this would maintain an ad free user experience for fans that come to my channel, while also allowing me to earn money from the use of my music in unauthorized non-official videos - this seemed like an acceptable balance and appropriate compromise.</div>
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Ok, so what are the deal terms? YouTube takes a flat 45% of ad revenue across the board.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote1"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#1">1</a></sup> Already, I hate the deal. There is no justification for YouTube’s cut to be that large. None. Yes, YouTube has bandwidth and server costs,<sup style="font-size: 9px; line-height: 8px;"><a name="footnote2"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#2">2</a></sup> and yes they are the ones selling the ad space - but they are also monetizing millions of videos, the content of which they don’t own and the creation of which they had no involvement in (at least for the vast majority of cases) - if the sheer volume of videos that YouTube is monetizing doesn’t sufficiently offset their costs (as is reportedly the case),<sup style="font-size: 9px; line-height: 8px;"><a name="footnote3"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#3">3</a></sup> they should raise the price of the ad space instead of taking a higher % from content owners. Let’s all keep in mind that nobody petitioned for the creation of the service - it shouldn’t be the burden of content owners to keep YouTube afloat financially (especially since it is the unauthorized appropriation of their content that forms the foundation of the service). </div>
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But it gets worse, because YouTube’s 45% cut is apparently of <i>net</i> profits, not gross.<sup style="font-size: 9px; line-height: 8px;"><a name="footnote4"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#4">4,5</a></sup> If you have a YouTube channel, try searching for the phrase “55% of net revenues recognized by YouTube” in your agreement…you might be surprised to discover that’s your share. In other words, YouTube recoups its costs (whatever they are deemed to be by YouTube) from the gross ad earnings, after which it keeps 45% of what’s left. I think we can all agree that is definitively monstrous. To be clear, these revenue splits are in connection with direct monetization of a YouTube channel’s content by the channel itself - and so in theory may not apply to Content ID revenue distribution, where content owners monetize other people’s unauthorized uploads of their content - however, I have been told by more than one source that Content ID splits are identical.</div>
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So out of the remaining 55% that goes to the content owner, the intermediary service would then take their commission, the amount of which varies depending on the company and the negotiating power of the content owner. Suffice it to say, there is a lot of bullshit when it comes to intermediary services, with some taking large percentages because they can, or because their clients simply don’t know any better. So unfortunately, this can be an area where a copyright owner gets an additional layer of exploitation. That being said, not all intermediary services are villainous, and some will agree to reasonable commissions. </div>
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I should also point out that a commission is warranted in virtue of the fact that someone has to manually monitor and respond to claim disputes that arise when uploaders contest the validity of various Content ID matches - occasionally Content ID does get it wrong, but most of the time uploaders of UGC either don’t understand what is happening and ignorantly dispute a legitimate copyright claim, or mistakenly invoke the “fair use” provision of copyright law, or intentionally try to game the system by disputing what they know is a legitimate claim in the hope that the content owner won’t respond in time (if a claimant fails to respond to a dispute within 30 days, YouTube automatically releases the claim). So there is certainly some labor involved, which is in direct relationship to the volume of copyright claims a given content owner has (the more claims, the more time required).</div>
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What I do object to however, is the principle that a content owner should be forced to engage an intermediary company to provide this service, and therein be forced to give up an additional % of revenue (whatever that % may be), especially when YouTube is taking 45% of net earnings. For that amount, YouTube should be assigning their own staff to monitor and resolve claim disputes, without forcing content owners to finance the process - after all, it is YouTube that created the platform in which such a process is necessary in the first place! And if YouTube doesn’t want to deal with the headache, preferring instead to outsource the task to intermediary services, so be it - but those service commissions should come out of YouTube’s share, not the content owners. This much should be obvious to anyone with any semblance of ethics, but to the extent corporations are people, they be bitches…</div>
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So here I was, caught between a rock and a hard place. On the one hand, I do not want to participate in an exploitative system. On the other, there is no alternative to stop my ongoing exploitation at the hands of 3rd parties. In the end, I can protest YouTube’s outrageous deal terms with respect to the videos I personally upload to my own channel by boycotting monetization - YouTube gets nothing, and I get nothing - fair enough. But boycotting Content ID affords me no benefits whatsoever - if I’m not monetizing UGC, someone else is (or will be), so I can either ensure those earnings come to me or I can let them go elsewhere (YouTube gets its cut either way). </div>
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Some might be tempted to think that perhaps there is still a moral victory in boycotting Content ID, but I would disagree - it’s simply a choice between letting one party exploit me (YouTube), and letting multiple parties exploit me (YouTube + UGC uploaders and Content ID abusers). Generally, I think it’s wise to minimize the number of people exploiting you to the greatest degree possible. And so, I have now joined the trend of monetizing UGC by enlisting an intermediary service.</div>
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Onwards and upwards…</div>
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After uploading my assets, Content ID got to work scanning YouTube for matches, a process that doesn’t finish overnight. After 4 months of searching, as of this writing Content ID has identified 191,735 videos that use my music (all without authorization). Some of these videos have millions of views, and some have less than a hundred. All together, the collective views during the 4 months that Content ID has been tracking them amount to 128,370,896…and accordingly, we can deduce that the total combined views since the respective upload date of each of these videos probably exceeds 1 billion. I have no way of knowing how many of these videos were monetizing my music beforehand, nor any way of determining how much money has been illegally made from my content to date. However, I am now making money from these videos, and no one can illegally claim and monetize my music ever again moving forward.</div>
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I can’t help but be perplexed at the fact that YouTube previously denied my Content ID application, when it turns out there are literally thousands of unauthorized uploads containing my music. I had no way of knowing this in advance, of course, but neither did YouTube…so what exactly was their evaluation based on? Whatever the criteria, it appears woefully insufficient, as 192 thousand copyright claims and millions of UGC views per month certainly warrants direct access to the service (access that should not be conditioned upon signing an unrelated Google Publishing Agreement<sup style="font-size: 9px; line-height: 8px;"><a name="footnote6"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#6">6,7</a></sup>). It seems to me that assessing a creator’s need for Content ID requires knowing how many of YouTube’s videos contain that creator’s content, something which can only be determined using Content ID itself, and therefore, that YouTube should not prejudicially withhold access to Content ID on account of mere guesswork and assumptions.</div>
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Importantly, it turns out that the advertising revenue being generated is significant. There are a variety of factors that determine how much money a given video earns, making it impossible to predict with any certainty what future earnings, or the earnings of others, will amount to; but the potential as a source of sustained income is clear. Of course, not every content owner will have 192 thousand claims - many will have much less (and some will have much more), but with a more equitable distribution of ad revenue, it could make a measurable difference in the life of a struggling artist. This is ultimately good news for an industry that is grappling with its transition into modernity, and for independent musicians hoping to make a living off of their craft. YouTube has created a system that has the ability to positively contribute to the music ecosystem, and this should be embraced and encouraged - at the same time, YouTube is currently exploiting content owners by taking an unfair share of the pie, and strong-arming creators into take-it-or-leave-it deals while tacitly leveraging piracy as a consequence of not conforming. </div>
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This should be decried at every turn, but too often, we’re instead exposed to claims of this or that creator making boat loads of money from YouTube revenue. Yes, that’s true - you can make boat loads of money. But what are the other players making as part of the deal? That should matter to you. You made 6 figures from YouTube, and I can potentially do the same? Wow, that’s fantastic. But think about it this way: if for every $1 you made, your “partner” was making $3, would you still feel good about that? I’d hope not, at least not when it’s your content that is the bedrock of the earnings, and not when you were bullied and essentially blackmailed into being a partner.</div>
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So the question is, can anything be done to improve this state of affairs? The short answer is, not really (at least not without changes to current copyright law). Even if I remove all of my personal uploads from YouTube, it won’t have any impact on the 192 thousand unauthorized uploads containing my music. It also won’t stop any of those users - and YouTube - from illegally monetizing my music. For clarity, let’s review:</div>
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1. Anyone can upload anything they want - if they upload copyrighted content without consent, YouTube is protected by safe harbor (i.e. “We said they needed to possess the necessary rights - we had no way of knowing the uploader didn’t own the copyright or have permission”).</div>
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2. If the user monetizes their unauthorized upload, YouTube is (apparently) still protected by safe harbor, despite directly participating in and sharing the profits generated (a fact that continues to baffle me).</div>
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3. Even if you’re willing to devote all of your time to finding unauthorized videos and sending YouTube DMCA notices to have them removed, not only is there not enough time in the day to complete this task, and not only will you have to indefinitely perform this task for the duration of YouTube’s lifespan, but in the best case scenario you will have only succeeded in taking down a small fraction of unauthorized videos, because the vast majority of UGC use copyrighted content anonymously (i.e. without crediting or listing the content in the video or video description). So the exploitation and illegal monetization will continue in the shadows.</div>
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4. The only way to locate all (or most) unauthorized content is by utilizing Content ID, presumably created expressly to solve the above problem. However, YouTube won’t issue you a Content ID account - they will force you to go to an intermediary company. And that intermediary company will require that you allow them to monetize the unauthorized uploads (otherwise there is no point in them being in business). And either way, you have absolutely no control over the deal terms of that monetization.</div>
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The genius of YouTube’s methodology is that all paths lead to monetization. In every scenario, YouTube earns money off of your content. I can loudly proclaim from the hilltops that I want no part in their advertising monetization system, but I am absolutely powerless to prevent YouTube (through the actions of its users) from monetizing my content - it will either happen legitimately with my consent, or illegitimately without my consent.</div>
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There is only one solution that can address this, and it requires having your own Content ID account. Armed with direct access, you could set the policy to “track only” - this would still place copyright claims on all unauthorized videos (preventing the uploader from being able to monetize the content), but it would also mean that no ads are placed on the videos…so you as a copyright owner wouldn’t make any money, but neither would YouTube. Consequently, if every label / publisher / intermediary service / creator that has direct access changed their settings from monetize to track, then the lost revenue to YouTube just might be enough to get them to the negotiating table. </div>
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Then again, Google earns unfathomable amounts of money overall, and might be content to simply wait out such a protest. In response, all said parties would have to be prepared to switch from “track” to “block” (effectively pulling the content off of YouTube). Consider that a very large percentage of YouTube traffic is music driven (it is apparently the largest music on-demand streaming service around),<sup style="font-size: 9px; line-height: 8px;"><a name="footnote8"><a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#8">8-12</a></sup> and the fact that music is used within an exorbitant amount of non-music-specific YouTube videos (e.g. home videos) - if you remove the music, you remove much of the incentive to go to YouTube, which undermines the YouTube culture, which lowers the value of the service to advertisers and weakens the brand overall … at that point, you stand a pretty good chance of motivating YouTube to resolve the issue, as they are likely too invested in the platform to let it wither away.</div>
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Of course, the above strategy requires coordination between multitudes of disparate companies and persons, in order to be effectively implemented en masse, and admittedly that is not likely to occur - but it remains possible nonetheless. If it were to happen, there is also the risk that independent artists unaffiliated with a label / publisher might get left out in the cold, with YouTube negotiating non-standard deals for major players exclusively (and for all I know, maybe this is already secretly the case). Regardless, the larger point remains - the entire YouTube edifice is built on a foundation of copyright owners’ creations, and to that end, is forever vulnerable to being dismantled at any moment - it just takes the will of creators to effect change. While I enjoy making money as much as the next person, I would be more than willing to leave it all on the table. What says you?</div>
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<hr width="80%"><p><span class="Apple-style-span" style="font-size: x-small;"><br />
<a name="1"><b>1 </b></a><a href="http://adage.com/article/digital/youtube-tv-sweetheart-ad-deals/245019/">"YouTube to Tv Networks: No More 'Sweetheart' Ad Deals for You!"</a> Ad Age. October 31, 2013.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote1"> ↩ </a>
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<a name="2"><b>2 </b></a><a href="http://variety.com/2013/digital/news/youtube-standardizes-ad-revenue-split-for-all-partners-but-offers-upside-potential-1200786223/">"YouTube Standardizes Ad-Revenue Split for All Partners, But Offers Upside"</a>. Variety. November 1, 2013.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote2"> ↩ </a>
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<a name="3"><b>3 </b></a><a href="http://www.businessinsider.com/youtube-still-doesnt-make-google-any-money-2015-2">"YouTube still doesn't make Google any money"</a>. Business Insider. February 25, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote3"> ↩ </a>
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<a name="4"><b>4 </b></a><a href="http://musictech.solutions/2016/03/20/youtube-revenues-explainer/">"YouTube Revenue Explainer"</a>. Music Tech Solutions. March 10, 2016.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote4"> ↩ </a>
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<a name="5"><b>5 </b></a><a href="http://www.jankysmooth.com/how-youtube-pays-artists-by-east-bay-ray-12-02-2015/">"How YouTube Pays Artists by East Bay Ray"</a>. Janky Smooth. December 3, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote5"> ↩ </a>
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<a name="6"><b>6 </b></a><a href="http://zackhemsey.blogspot.com/2015/01/the-dark-side-of-youtube.html">"The Dark Side Of YouTube"</a>. Zack Hemsey Official Blog. January 28, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote6"> ↩ </a>
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<a name="7"><b>7 </b></a><a href="http://zoekeating.tumblr.com/post/108898194009/what-should-i-do-about-youtube">"What should I do about YouTube?"</a> Official Zoe Keating Blog. January 22, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote7"> ↩ </a>
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<a name="8"><b>8 </b></a><a href="http://www.wsj.com/articles/SB10000872396390444042704577587570410556212">"Forget CDS. Teens Are Tuning Into YouTube"</a>. The Wall Street Journal. August 14, 2012.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote8"> ↩ </a>
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<a name="9"><b>9 </b></a><a href="http://www.theverge.com/2015/8/28/9220377/youtube-as-you-know-it-is-about-to-change-dramatically">"YouTube as you know it is about to change dramatically"</a>. The Verge. August 28, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote8"> ↩ </a>
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<a name="10"><b>10 </b></a>"<a href="http://www.bbc.co.uk/newsbeat/article/15431310/youtube-boosted-by-music-videos-to-pull-behind-facebook">YouTube boosted by music videos to pull behind Facebook"</a>. BBC. October 26, 2011.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote8"> ↩ </a>
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<a name="11"><b>11 </b></a><a href="http://www.musicbusinessworldwide.com/youtube-is-the-no-1-music-streaming-platform-and-getting-bigger/">"YOUTUBE IS THE NO.1 MUSIC STREAMING PLATFORM - AND GETTING BIGGER"</a>. Music Business Worldwide. July 6, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote8"> ↩ </a>
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<a name="12"><b>12 </b></a><a href="http://www.digitalmusicnews.com/2015/09/14/youtube-music-is-growing-60-faster-than-all-other-streaming-music-services-combined/">"YouTube Music Is Growing 60% Faster Than All Other Streaming Music Services Combined"</a>. Digital Music News. September 14, 2015.<a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html#footnote8"> ↩ </a>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com13tag:blogger.com,1999:blog-801873645877244873.post-72774688632554343432015-10-20T09:58:00.000-04:002015-10-20T10:08:49.718-04:00Fuck Singles<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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We’re all familiar with the standard industry practice of bands and recording artists releasing “singles” in advance of a new album’s release. This is so commonplace, and has been going on for so long, that no one ever seems to question the philosophy or merits behind it. Well, I think it’s time someone lay waste to what is in my estimation a misguided undertaking.<br />
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Let’s begin by examining the often-cited motivation for releasing singles - generating a “buzz” - that electric gossip over something so cool and interesting that no one can stop talking about it. Without a buzz, your album will be released into anonymous oblivion amidst the endless sea of content that humanity swims in; the world won’t stop to take notice of your contribution, and no one will realize you even exist. But fear not, for the single has the potential to avert this creative and existential disaster. This is that one song that will change everything. A song so special, it makes you believe in magic. Yes, the single holds the power to generate that coveted buzz, but…and this is the important part…it must be released <b><i>in advance</i></b> of the album to which it belongs! Failure to abide by this tenant will render the single powerless; for reasons unknown, people simply will not feel the same way about the song otherwise.<br />
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So this is the apparent mythology at work. But while I am certainly not opposed to the principle of generating a buzz, I would rather do without the supposed benefits that result from this exercise. After all, why would I want listeners to hear only one song from an album? This doesn’t make sense to me, and even less so in situations where a single (or singles) are released months in advance of the album, such that by the time the album becomes available, listeners’ perception of the entire body of work is unavoidably distorted on account of having heard the single(s) out of context and disproportionately more frequently. Fuck that. When I finish an album, I release the album.<br />
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Now there are some that view the single as being representative of the album as a whole - that it functions as a sort of emissary, communicating the identity of the new album to listeners. However, unless every song sounds the same, this is an aural impossibility. And while I suppose a single could be representative of the spirit of the overall work, heterogeneity notwithstanding, and while I also concede that there are albums in which every song does in fact sound the same, there is nevertheless no compelling reason to release that single <span style="text-decoration: underline;"><i>in advance</i></span> of the album’s release. Unless of course the album is subpar, in which case the utility of an advanced single lies in deceiving your audience in an attempt to manipulate listeners into pre-ordering an album they haven’t had the ability to vet, or buying it on faith upon release. Fuck that. I am not in the business of aural bait-and-switchery.<br />
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This brings us to the idea that singles constitute the “strongest” songs on an album, a notion that once again implies a subpar album, and to which I again refer you to my lack of interest in bait-and-switchery. But I am also confused by the principle of an artist / label creating a work that is comprised of “strong” and (by implication) “weak” songs. If a song is weak, why the fuck is it on the album? Of course, it may very well end up that a listener gravitates to one particular song on an album while ignoring the rest of the work, in which case, so be it…but I’m not going to decide or predict on their behalf which song on that album they will / should perceive as being more worthy of their attention than others, nor will I assume that such an outcome is a forgone conclusion. Fuck that.<br />
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Still, there remains the practical consideration of radio play (be it traditional or digital in nature). Stations aren’t going to play an entire album, so you need to deliver a single in order to participate in the process. Well, note there is nothing inherent in this concept that requires delivering a single in advance of an album’s release; not to mention, it makes more sense for people to fall in love with a song whose album they can immediately purchase or stream, rather than have to wait a few months, at which point they will hopefully a) remember there was an item they were previously interested in, b) realize this item has now become available, and c) still be interested in it. And correct me if I’m wrong, but shouldn’t the stations / DJs / tastemakers decide which song(s) to play from a given album? Otherwise, what purpose do they serve, apart from feeding the masses musical fodder as directed by their label overlords? And while we’re at it, why should there be a moratorium on playing multiple songs or a full album from an artist? Am I crazy to think that stations should simply play whatever music they think best satisfies the genre / style parameters they seek to service? What’s with all the arbitrary and contrived rules about music consumption?<br />
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In light of the above, I have been and will continue to be a conscientious objector to this indefensible pastime. The only singles you will find from me are self-contained songs that do not belong to a larger body of work. After all, that’s what a single should be…one single fucking song!!!!</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com11tag:blogger.com,1999:blog-801873645877244873.post-54177505905880007572015-09-11T10:56:00.000-04:002015-09-13T10:58:51.646-04:00The Hemsey Hold<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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When my daughter turned 1 year old last month, the occasion sparked a look through the good old photo library. Lo and behold, we uncovered pictures of a rather unique practice, one which we had forgotten all about - it was a method of holding Scarlet that has come to be known as the "Hemsey Hold” (trademark and patent pending).<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQb0hsk6Juwj1xsZMmQIrOvsfnwVixcwPnaXUFBSotEFxvlsb8zYJ5S-WBYmMvcMKl7yqKBMtkWOkHQMqw5LeEltfXAmfqKVQeMa3S1kZmcuREFXHRNYoIEq5wLuyhPR_T-hfaLCWrTDox/s1600/Hemsey+Hold+1.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQb0hsk6Juwj1xsZMmQIrOvsfnwVixcwPnaXUFBSotEFxvlsb8zYJ5S-WBYmMvcMKl7yqKBMtkWOkHQMqw5LeEltfXAmfqKVQeMa3S1kZmcuREFXHRNYoIEq5wLuyhPR_T-hfaLCWrTDox/s400/Hemsey+Hold+1.JPG" width="400" /></a></div>
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On first glance, it may look like my daughter is being suffocated, or attacked by a face sucker out of the <i>Alien</i> franchise, but rest assured she is alive and well (and not carrying an alien pod inside her…as far as we know). The baby is sucking on my wife’s pinky finger, with the remaining fingers covering her eyes and face, while all of the weight is distributed across two hands, two boobs, and one forearm, working in concert to form the perfect baby cocoon. This was typically accompanied by a soft rocking up and down, while walking about. <br />
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It’s not something that we planned in advance or purposefully designed; it just sort of happened one day, as we navigated the task of soothing an infant without a pacifier. And I can tell you that the Hemsey Hold is in fact the ultimate soothing and putting-to-sleep method of any we ever tried, and is quite comfortable for mom to boot. Darkness + Rocking + Sucking + Close Proximity To Mom and Boobs + Lying Face Down = Content Baby. <br />
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I can also tell you that the hold is tailor made for moms, but less so for dads - while men certainly can perform the maneuver, their lack of breast tissue means the arms have to carry all the weight, and so it becomes a test of endurance, one which you will inevitably lose given enough time. But women will be capable of going the distance, as much of the baby’s weight gets supported on their mammary shelf.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCocIJHPmeZ3s_YUHKF7S7PJUVoVUgm1DBa0k-jurAb8OaYRAZr_hm-rbKBwDZr0xN_ys9ImG1ze4uhDe3pj2-RdV4UH6_xOImtPQgrRYb-f7_R0XMB0EzgJTxWGtzK392_9Pi8Pd0v1zj/s1600/Hemsey+Hold+2+%2528crop%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCocIJHPmeZ3s_YUHKF7S7PJUVoVUgm1DBa0k-jurAb8OaYRAZr_hm-rbKBwDZr0xN_ys9ImG1ze4uhDe3pj2-RdV4UH6_xOImtPQgrRYb-f7_R0XMB0EzgJTxWGtzK392_9Pi8Pd0v1zj/s400/Hemsey+Hold+2+%2528crop%2529.jpg" width="400" /></a></div>
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I encourage all those intrigued to give it a try…just be prepared for some puzzled stares if you do it in public. We haven’t utilized the Hemsey Hold since Scarlet was about 5 months old, but we’re prepared to break it out again when she eventually goes through puberty, or turns 16. And for anyone who may be worried that this technique will in some way impede their child’s development, fear not; as you can see below, Scarlet has ended up just fine.<br />
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com4tag:blogger.com,1999:blog-801873645877244873.post-38571349132421574832015-08-12T16:37:00.000-04:002015-08-14T10:24:35.036-04:00I Swear, I Did It For Acoustic Reasons<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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When I finished renovating my studio in 2014 (<a href="http://zackhemsey.blogspot.com/2014/10/rome-wasnt-built-in-day-and-neither-was.html" target="_blank">see here</a>), I knew there was still one element that needed addressing: my computer monitor. Sure, it was a decently sized 30”, but at ten years old the resolution wasn’t the best, and additionally it felt obtrusive in the room…like when someone sticks their genitals in your face while you’re trying to make an origami. <br />
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Although the computer screen was positioned far enough back to avoid blocking the direct sound path from the speakers, it still hovered over the apex of the desk, so if you leaned too far forward it caused a “window” type of effect on the frequency spectrum, making it sound goofy. And I wondered if a 30” surface hovering in mid air might be creating some unwanted acoustic reflections.<br />
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Of course, if you remove the computer screen, you have to replace it with something else. And what better thing to replace it with than a giant flat screen TV flush against the wall? This would give you everything: no reflective surface hovering above the desk, no “windowing” when leaning forward, and aesthetic awesomeness. <br />
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But not just any TV would do - it would need to be big enough and sharp enough to allow comfortable viewing, and most importantly comfortable reading, at a distance of 7-8 feet. Upon testing in the field (i.e. hooking up a laptop to various TVs in-store) I confirmed the only suitable candidate was a 4k TV at 58”. This would yield super crisp text from the computer at the required distance, and would optimally maximize the space in between the speakers.<br />
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So earlier this year I put my plan into action, and the result speaks for itself:<br />
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com14tag:blogger.com,1999:blog-801873645877244873.post-75183223578080213012015-04-23T11:51:00.000-04:002015-04-23T11:52:52.336-04:00Male Ring Card Girls<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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I’m not sure when the custom of ring card girls began in combat sports, but the history of how it came to be is less interesting than the question of why the custom persists. I concede that it may be difficult for intoxicated onlookers to retain exactly which round is about to transpire, but I imagine it’s even harder to retain such information when it’s delivered via scantily clad women with bouncing appendages. So it’s fair to say the utilization of ring card girls hasn’t lingered for practical reasons.<br />
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Of course, men (and some women) enjoy any excuse to fix their eyes upon the female anatomy. But I’m not convinced that’s all there is to the story. After all, there are other sports (even male-dominated ones) which lack any equivalent. Sure, there are some similarities between ring card girls and the cheerleaders that perform at football and basketball games, but these are distinctly different phenomena. And ask yourself, why don’t we have ring card girls at the DMV? Or at the grocery store? Or at funerals? Why aren’t they holding up signs listing the current wait time, or a ticket #, or the parting words of the deceased? If it were truly as simple as “it’s fun to look at hot chicks”, wouldn’t we have found a way to expand their contributions to society? Indeed, the exclusivity among combat sports is intriguing.<br />
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Ultimately, I don’t think the custom is much thought about one way or the other, neither by spectators, combatants, promoters, event planners, nor the participants themselves. It’s just something that is done, and seemingly always has been. At best, the practice is an archaic pastime that endures out of a sense of nostalgia, serving as a celebration of the human form, while providing a helpful reminder of the upcoming round as an added bonus. At worst, it is a demeaning exercise without any utility whatsoever, fostering a strange mix of sex and violence while engaging some latent archetype of the male psyche unconsciously rooted in fighting over the female sex. <br />
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All of that is fine. I have no problem gazing upon attractive women as they walk around in circles. But what strikes me as totally unacceptable in 2015, a time when females comprise a sizable and growing portion of MMA athletes, a time when the 135 lb champion Ronda Rousey is widely regarded as one of the best pound for pound fighters in the world (and one of the biggest stars in sports overall), is that there are no male ring card girls. This, quite frankly, is an outrage. It undermines the ideals of equality that we tirelessly strive toward as a society, it’s disrespectful to female fighters, and it should be highly offensive to you. But most of all, it’s damaging to all the young boys out there who aspire to be the greatest ring card girls the world has ever seen. Maybe you can sleep at night knowing we’ve trampled the dreams of our youth in blindly clinging to this custom, but I cannot. <br />
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I want to see scantily clad men in speedos and loin cloths parading around the octagon, doing their part to ensure everyone is aware of the upcoming round. Rather than 3 designated ring card chairs filled with lady parts, I want to see 6 chairs next to the UFC cage occupied by male and female kibbles and bits. And I want to applaud both sexes as they demonstrate how nimbly they walk while simultaneously holding up cards that show information more effectively communicated via the giant screens already present at each venue, and then deftly sit down ringside. And I want to know that every MMA fan, whether male, female, straight, or gay, can behold a ring card girl within their attractive domain.<br />
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If we come together, we can turn this dream into a reality. The world, and MMA, can be better. We just have to choose to make it better. Write to your representatives. Write to your favorite fighters. Write to the UFC. And proudly spread the message that everyone should have the right to become a ring card girl, even if they have testicles.</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com35tag:blogger.com,1999:blog-801873645877244873.post-21107420893705892552015-03-05T00:17:00.000-05:002015-07-04T21:59:51.141-04:00The Puzzling Case of GBS<br />
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<i>1. What is GBS?</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section1"> ↩ </a><br />
<i>2. GBS in the United States</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section2"> ↩ </a><br />
<i>3. GBS and IAP Studies</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section3"> ↩ </a><br />
<i>4. The Source of GBS Rates</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section4"> ↩ </a><br />
<i>5. Examining the GBS Narrative</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section5"> ↩ </a><br />
<i>6. Fluctuating Variables</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section6"> ↩ </a><br />
<i>7. GBS Hospital Surveys</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section7"> ↩ </a><br />
<i>8. GBS by Gestation</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section8"> ↩ </a><br />
<i>9. GBS by Race</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section9"> ↩ </a><br />
<i>10. Late-Onset GBS</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section10"> ↩ </a><br />
<i>11. GBS and the Cesarean Complication</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section11"> ↩ </a><br />
<i>12. GBS False Negatives / Positives</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section12"> ↩ </a><br />
<i>13. GBS and Mortality</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section13"> ↩ </a><br />
<i>14. GBS at the State Level</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section14"> ↩ </a><br />
<i>15. GBS Around the World</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section15"> ↩ </a><br />
<i>16. Risks of IAP</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section16"> ↩ </a><br />
<i>17. Alternatives to IAP</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section17"> ↩ </a><br />
<i>18. GBS Conclusions</i> <a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#section18"> ↩ </a><br />
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<span style="text-decoration: underline;"><a name="section1">What is GBS?</a></span></div>
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Your body is literally teeming with microbes - tiny organisms invisible to the naked eye. In fact, you actually have more microbes than you do human cells. Countless species of bacteria live in every nook and cranny you have to offer, from your skin, to your hair, fingernails, mouth, intestines, and colon. For some, the thought of being covered in bacteria may be disturbing, but the reality is that we need them as much as they need us. All of the bacteria in our bodies have coevolved with us, such that they perform essential tasks within our physiology and play a vital role in our immunity.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,2</a></sup> They are quite literally indispensable to our health.</div>
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Of course, bacteria also have the propensity to cause illness, but it’s important to understand that there is a difference between being colonized with a bacterium and being infected by it. Colonization involves a mutually beneficial (or neutral) arrangement, whereby bacteria live inside you without causing sickness. Your body is a source of food and shelter for your microbes, and it is generally not in their interests to destroy their own habitat - in fact, the native bacteria within you actually protect and defend against invading pathogenic microbes. Having said that, the microbiome is a dynamic system, in which the right set of conditions can lead to changes in the makeup, distribution, and behavior of our microbes…and thus, within certain contexts, normally harmless microbes can become harmful.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> So we are walking ecosystems, the balance of which directly relates to our well being.</div>
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There is a specific bacterium called group beta streptococcus (GBS) that is carried by 10-30% of the female population.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> This bacterium lives in the intestines, rectum, and/or vagina, and its colonization can be transient - that is, a woman may carry it this month, and not the next.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4</a></sup> Most of the time its presence is asymptomatic, but occasionally group-b strep can cause health complications such as urinary tract infection, or in the extreme, serious life-threatening infection in the form of sepsis, pneumonia, or meningitis.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,4</a></sup> Infection in adults occurs primarily among elderly and those with medical conditions,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#5">5</a></sup> but surprisingly, GBS infection is most common among newborn babies. The consequences of neonatal infection can be quite grim: from long term neurological damage, to hearing or vision loss, to fatality.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#6">6,7</a></sup> Fortunately such horrific outcomes are only a subset of overall infection cases, but even when no permanent damage is sustained, GBS neonatal infection remains a highly traumatic and disruptive ordeal for families. </div>
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If this all sounds pretty scary, it should. But don’t climb into your panic room yet - just as the majority of women colonized with GBS do not exhibit any adverse side effects, so too the majority of babies born to GBS colonizers do not develop infection. In fact, the percentage of babies that develop a GBS infection is remarkably minuscule - between 0.5 and 2% of newborns born to GBS colonized mothers<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,8</a></sup> - in practice, this amounts to less than 2 cases of infection for every 1,000 babies that are born. While such incidence is rare, given the devastating effects when GBS infection does strike, it certainly makes sense to attempt to reduce or eliminate its occurrence to the greatest degree possible.</div>
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There are two categories of infection that occur in newborns, early-onset and late-onset. Early infection occurs within the first week of life, and late-onset between 7 and 90 days after birth. Although both involve the GBS bacterium, they are evaluated separately. Prevention efforts to date have been focused on early-onset infection. </div>
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We know that early-onset infection takes hold in the vicinity of birth, because symptoms typically manifest within the first 24 hours of life. There are a variety of maternal and labor risk factors that have been associated with it, the presence of which are believed to increase the likelihood of infection occurring, but a sizable portion of infections do not exhibit any clinical risk factors.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9-11</a></sup> GBS infection can manifest in both vaginal and Cesarean delivery, with or without prolonged rupture of membranes, and in both full term and preterm births, all of which leads to the deduction that the bacterium must be capable of traveling vertically up the vaginal canal to the uterus, wherein the baby is presumably swallowing amniotic fluid containing the bacterium.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#12">12</a></sup></div>
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At the end of the day, we simply can’t predict when GBS infection will occur, but it seems self-evident that you cannot have GBS infection without the GBS bacterium being present in the first place. To that end, GBS colonization is considered to be the most predictive and reliable risk factor, and accordingly the medical community in the United States has adopted a strategy of screening all women for GBS at 35-37 weeks of pregnancy, and then treating those with positive cultures using intravenous antibiotics during labor, commonly referred to as IAP (intrapartum antimicrobial prophylaxis).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> </div>
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Testing is done at 35-37 weeks because it takes a few days for cultures to be analyzed, and results are required before the onset of labor (the timing of which obviously varies from woman to woman). Given the transient nature of the GBS bacterium, this methodology allows for the possibility that GBS colonization status will change between the time of the test and the time of delivery. So utilization of a “rapid test” in which a culture could be quickly analyzed on the spot during labor would be ideal, but such has not yet become available to clinicians. Nevertheless, it is said that culture results obtained at 35-37 weeks match GBS status during delivery with 87-96% accuracy.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#13">13</a></sup> </div>
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Now, if the prospect of administering antibiotics to every GBS colonized mother, when only .5-2% of their babies are at risk of developing GBS infection, strikes you as inelegant … that’s because it is inelegant. However, IAP was not intended to be a perfect or permanent solution; it was intended to provide a temporary fix until a better solution was devised (such as a GBS vaccine)<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#14">14</a></sup> - and at the end of the day, it doesn’t need to be elegant, it just needs to work. To that end, since adopting IAP protocols, the U.S. has observed its lowest incidence of GBS early-onset infection to date. Success! Case closed then, right? Well, this is where things get interesting.</div>
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<span style="text-decoration: underline;"><a name="section2">GBS in the United States</a></span></div>
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Below is a graph from the CDC<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> showing GBS infection rates in the U.S. between 1990 and 2008.</div>
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Early-onset rates began to decline in correlation with statements from the gynecological and pediatric community, which outlined practices believed to be effective in reducing GBS infection, followed by definitive prevention recommendations by the CDC in 1996 and 2002. The initial 1996 recommendations entailed a choice by the healthcare provider to utilize either a risk-based strategy (i.e. presence of risk-factors determine who receives antibiotics) or a universal screening strategy (treating anyone colonized with GBS, regardless of risk factors). Then in 2002, based on a study comparing the effectiveness of both strategies, the CDC revised their recommendations to adopt universal screening only, which was found to be over 50% more effective.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#11">11</a></sup></div>
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The above correlation is consistent with the claim that IAP reduces the incidence of GBS early-onset infection, but in and of itself, it does not constitute actual evidence. It’s only an observation, and it’s important to understand that correlation is not synonymous with causation. That is to say, two things can appear to be related to each other without a causal component being involved. So the question is whether infection rates declined coincidentally with the implementation of IAP, or if they declined specifically <i>because</i> of IAP. The latter is the belief, and it is certainly a sensible one. However alternative scenarios could also explain the observation (for example, natural changes in GBS colonization or virulence). So in order to determine if a correlation entails actual causation, you need to conduct clinical research, the gold standard of which is double blind randomized controlled trials - in the case of GBS, this would entail comparing the effectiveness of IAP to a placebo, such that neither patient nor provider knew what was being administered.</div>
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<span style="text-decoration: underline;"><a name="section3">GBS and IAP Studies</a></span></div>
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There are only a few randomized controlled trials that have tested the effectiveness of IAP.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#15">15-17</a></sup> The CDC’s recommendations are fundamentally based on a handful of studies from around the late 1980’s, which demonstrated IAP was 80% effective in reducing GBS early-onset infection.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#18">18</a></sup> The problem, however, is that those studies suffer from a wealth of flaws. A review by the Cochrane Collaboration (a well respected research group) found a high risk of bias in a variety of areas “sufficient to affect the interpretation of the results” and which “seriously weakens confidence in the results.” Ultimately the findings were held to be too flawed to inform clinical procedure, and the review concluded that “there is a lack of evidence from well designed and conducted trials to recommend IAP.”<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#19">19</a></sup> Nonetheless, the studies in question are the only randomized controlled trials that have been published to date on this issue (and of course, they did end up influencing clinical procedure).</div>
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Non-randomized and observational studies have been done to assess the impact of IAP. To that end, many have shown IAP has a statistically significant effect in reducing GBS early-onset.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#20">20-24</a></sup> However, other studies show effects that are not statistically significant,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#25">25,26</a></sup> and some show IAP is of little value in treating low birth weight infants.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#27">27,28</a></sup> There is also a 1993 meta-analysis of IAP research which concluded IAP is effective,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#29">29</a></sup> but this was followed by a 1994 meta-analysis which concluded IAP’s effectiveness is not sufficiently supported by the available evidence.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#30">30</a></sup> Then another study from 1999 concluded that the available IAP research was not suitable for formal meta-analysis, due to a wide variety of factors, limitations, and flaws, but that despite such shortcomings the data was not “compromised beyond utility,” and ultimately concluded that IAP is effective.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#18">18</a></sup> </div>
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At the end of the day, double blind randomized controlled trials are the gold standard of research for a reason - namely, because anything short of these rigors has the potential to mislead. This is why the paucity of clinical trials and the Cochrane analysis is troubling. That being said, as one professional mentioned to me in conversation, there are practical and financial limitations to conducting randomized controlled trials for every single aspect of healthcare, and if such was a requirement for making policy decisions, nothing would ever get done. This person illustrated the point with a colorful example, “would you advent a randomized controlled trial to evaluate the merits of a parachute?” I would not. However, the comparison is faulty, and regardless, GBS prevention was obviously an area in which such clinical research was deemed to be necessary, since a few trials were conducted. So given the discrepancies in the research mentioned above, I’m left unsettled.</div>
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Now, if the quality of existing IAP research does not meet our highest standards, then why not simply conduct new clinical trials in the modern era to sort this out? Well, from what I’ve gathered, it would be considered unethical to conduct such a study, because we can’t deny pregnant women with GBS access to effective treatment. Of course, this is comical given the effectiveness of treatment is exactly what we’re looking to establish. And moreover, is it not unethical to administer antibiotics to laboring women in the absence of reliable clinical evidence?<br />
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So we find ourselves back at square one. The problem posed by this information gap is more than simply academic, in light of the fact that IAP is not without associated risks. In weighing the costs of these risks against the benefits of preventing infections, naturally it’s important to know that IAP really is reducing GBS early-onset rates. So before we explore the risks involved with treatment, we must utilize other means of analysis to further investigate the merits of IAP.</div>
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<span style="text-decoration: underline;"><a name="section4">The Source of GBS Rates</a></span></div>
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In the United States, GBS infections are tracked through the Active Bacterial Core surveillance network (ABCs), which monitors the presence of six different invasive pathogens in the general public. It is a coordinated effort between the CDC, state health departments, and universities. The network was officially established in four states in 1995, after which a series of expansions ensued and by 2004 it grew to comprise 10 states, where it remains today.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#31">31,32</a></sup></div>
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Prior to ABCs, the CDC had established precursor sites that conducted population-based surveillance of GBS between 1988 and 1994 - these were subsets of what eventually became the ABCs.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#33">33,34</a></sup> Before 1988, there is no population-based surveillance data for GBS.</div>
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The expansion of ABCs coincides with the observed decline in early-onset rates. So we have to ask whether this expansion could be skewing our perceptions of GBS incidence over time. To that end, because the rate of late-onset infection has been stable throughout the expansion, it is believed that the decline in early-onset is a genuine decline and not a surveillance artifact.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#35">35</a></sup> In addition, disease trends within consistent surveillance areas have been reported to closely match trends when all 10 surveillance areas are combined.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup></div>
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One other thing to note is that the current GBS surveillance network covers about 10% of the U.S. population.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9</a></sup> So there is a general question as to how reliable national projections based on 10% of the population are, and the CDC is aware that ABCs data may not be generalizable to the entire U.S.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#38">38</a></sup> Nevertheless, by tracking the rate of infection within ABCs over time, we can observe disease trends within the surveillance population and glean useful information. Having said that, it’s important to remember that ABCs can’t tell us why disease trends change or explain their behavior - it can only report the trend in and of itself.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">39</a></sup> </div>
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<span style="text-decoration: underline;"><a name="section5">Examining the GBS Narrative</a></span></div>
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Let’s take another look at the graph from earlier, showing GBS infection rates between 1990 and 2008. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN37jk9335WqQIYwKrAtA8vDoeP8o89TNNtD35W3M4J3fTRLhmAavM-HWjjzq0CbgU6TlY03gS6ZlD5Ne0l61p_srUeWb683G0AY_NXOn-Q8r7AETzl0xOCizDfwZe_5fotP4Qauz3Q0rw/s1600/01+CDC+2010+-+Figure_1_GBS_Decline.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN37jk9335WqQIYwKrAtA8vDoeP8o89TNNtD35W3M4J3fTRLhmAavM-HWjjzq0CbgU6TlY03gS6ZlD5Ne0l61p_srUeWb683G0AY_NXOn-Q8r7AETzl0xOCizDfwZe_5fotP4Qauz3Q0rw/s1600/01+CDC+2010+-+Figure_1_GBS_Decline.png" height="297" width="320" /></a></div>
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From 1993 onwards, the amount of hospitals implementing IAP began increasing, as well as the degree of compliance with national guidelines among hospitals (e.g. using appropriate media when culturing for GBS, taking both vaginal and rectal specimens when screening, etc).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#40">40-42</a></sup> All of this correlates with the decline in GBS early-onset, although it is not clear how much credit can be given to IAP between the years 1990 and 1996 - while IAP had begun to be implemented in limited fashion during this period, the degree of compliance therein was far from optimal, yet rates were declining substantially nonetheless.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#10">10</a></sup></div>
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The above graph begins at 1990, however a previous graph published by the CDC included data for the year 1989.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#43">43</a></sup> Early-onset was listed somewhere between 1.4 and 1.5, with late-onset at 0.4. I’m not sure why the 1989 figure was subsequently omitted. </div>
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Also, the early-onset rate for 1990 is listed at around 1.8. However, a population-based study published in 1992 reports an early-onset rate of 1.4 in 1990.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44</a></sup> There is a similar discrepancy between the rates of late-onset infection as well, cited at 0.3 in the study but listed higher by the CDC. It seems that the CDC’s graph is adapted from a 2008 study<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> in which GBS rates for 1990 were calculated from a surveillance population that did not include a region from the 1992 study’s surveillance population - the entire state of Oklahoma - and this could explain the discrepancy between the reported rates for 1990. While small differences of this kind may seem trivial at face value, they can be crucial when assessing the effectiveness of a protocol that treats an inherently rare phenomenon. Tiny alterations matter.</div>
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As to why researchers in the 2008 study would exclude Oklahoma from their 1990 calculation, this was not explicitly addressed, so one can only speculate. Perhaps they felt its exclusion yielded a more consistent surveillance population (since Oklahoma did not end up becoming part of the ABCs network), and thus a more reliable comparison of GBS incidence over time. However, the more data available, the more accurate the portrayal of disease burden will be, and since ABCs network expanded over the years anyway, I fail to see why the inclusion of Oklahoma in the 1990 calculation would be any more subversive than the addition of new states after 1995. So I am uncomfortable excluding relevant data in this way.</div>
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Now, obviously GBS infections didn’t appear out of nowhere in 1989. GBS as an infectious agent is said to have “emerged” in the 1970’s, for reasons unknown.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#37">37,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#45">45,46</a></sup> There are isolated reports, prior to the establishment of surveillance networks, that cite early-onset infection rates of 2-3 per 1,000.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,9</a></sup> However, these are based on single hospital studies and/or small geographic areas, which may or may not be accurately representative of overall disease incidence.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#14">14,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#34">34,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44</a></sup> Nevertheless, that’s all we have to go by. </div>
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So let’s take a look at a new graph that I have assembled (click to enlarge), inclusive of all of the above information, along with additional surveillance data for 2009-2012.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh67qewuLHkP0PrrTlrnFp3seeBU_8HPBigf3hOCAdiDu5tYW0y_vJCoGMEjaTt9hf4cF4KnhMsCAbnEOBMi6bmgk3vZsmAxnIVKR4xGMD5jm_yagWkp5lrKElnTn9_wlSxfsBSkWEjKE4r/s1600/02+ZH+-+United+States+1970-2012.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh67qewuLHkP0PrrTlrnFp3seeBU_8HPBigf3hOCAdiDu5tYW0y_vJCoGMEjaTt9hf4cF4KnhMsCAbnEOBMi6bmgk3vZsmAxnIVKR4xGMD5jm_yagWkp5lrKElnTn9_wlSxfsBSkWEjKE4r/s1600/02+ZH+-+United+States+1970-2012.png" height="261" width="320" /></a></div>
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An alternative narrative has now become visible. If GBS infection rates were as high as reported in the 70’s and 80’s, then the obvious question is why did they decline of their own accord by 1990? Going from 2-3 cases to 1.5 cases per 1,000 births is a rather significant change to have transpired without any IAP contribution. If early-onset rates were already declining prior to the implementation of IAP, this would cast doubt on IAP’s causal role in their continued decline. Of course, it’s possible that the estimated incidence of 2-3 per 1,000 in the 70’s and 80’s is not accurate - maybe it was actually lower or higher. If lower (and there are reported estimates of 1.3 and 1.09 per 1,000),<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#47">47,48</a></sup> with rates stable or increasing leading into 1990, then this would be consistent with IAP’s efficacy. But if higher (and there are reports of 5.1, 5.4, and even 10 per 1,000),<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#11">11,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#48">48,49</a></sup> then this would cast even greater doubt on IAP’s efficacy.</div>
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<span style="text-decoration: underline;"><a name="section6">Fluctuating Variables</a></span></div>
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GBS wasn’t always a major cause of neonatal infection, and whatever factors led to the emergence of GBS, presumably changes in those factors would lead to changes in GBS incidence. But since we don’t know the conditions that led to the emergence of GBS disease in the first place, we’re not in a position to identify if / when those conditions change. Moreover, since we don’t have sustained reliable surveillance prior to IAP efforts (e.g. population-based surveillance for a 10 year period with no intervention efforts), we can’t presume to know what degree of fluctuation naturally occurs (if any), in order to compare against trends during the intervention era - by the time reliable surveillance began in the ABCs precursor sites, GBS was already on the radar of the medical community and it was not long before IAP began to be implemented in limited fashion.</div>
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In examining GBS disease trends, an important variable is colonization rates. GBS colonization is not continuously tracked, so we extrapolate general colonization rates from various studies that have been done over the years. The trouble is that there are a wide range of reported rates,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#22">22,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#49">49-57</a></sup> so it’s no surprise that the CDC estimates between 10 and 30 percent of women are colonized…apparently colonization fluctuates.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4</a></sup> However, 10-30% is a rather large window, and it’s important to note that changes in overall colonization can have consequences to the overall incidence of GBS infection.</div>
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For the sake of discussion, let’s assume that 1% of colonized mothers have babies that develop infection. At 4 million births in a year, an overall colonization rate of 10% would result in 4,000 infections, whereas a colonization rate of 30% would result in 12,000 infections. That’s quite a difference! So if colonization rates change from one period to the next, so too would the amount of infections automatically. But of course, the percentage of babies that develop infection isn’t precisely 1%…it’s reportedly between .5 and 2%.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,8</a></sup> Now we have another fluctuating variable. Assuming a colonization rate of 20% among 4 million births, an infection rate of .5% would yield 4,000 infections - but an infection rate of 2% would yield 16,000 infections! So the interaction of both of these variables can lead to increases or decreases, having nothing to do with intervention efforts.</div>
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Ideally, culture screening results should be part of the data regularly collected and tracked by ABCs, as this is the only way to factor colonization rates into an analysis of infection rates. But alas, this is not the case.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#88">88</a></sup> Nevertheless, it is important to realize that an incidence of 1.5 per 1,000 births within the context of a 30% colonization and 2% infection rate, means something very different than 1.5 per 1,000 births within the context of 10% colonization and .5% infection rate. Without being able to track these variables, we cannot accurately interpret observed disease trends. As one editorial stated: “We should keep in mind that colonization and infection rates due to GBS change over time, and the results we have seen following…guidelines may be only temporary associations without causal relationships.”<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#58">58</a></sup></div>
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<span style="text-decoration: underline;"><a name="section7">GBS Hospital Surveys</a></span></div>
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Perhaps in an effort to get around these limitations, various hospital surveys have been conducted over the years, in order to calculate the proportion of hospitals implementing IAP and compare the infection rates between hospitals with and without IAP protocols. </div>
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A survey of births from 1994 found that hospitals with a screening policy of any kind had fewer early-onset infections than hospitals without a screening policy.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#40">40</a></sup> Another survey of births from 1996-1997 found hospitals that established or revised their IAP policies in 1996 had a significantly lower average amount of early-onset infections in 1997.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#59">59</a></sup> Interestingly, there was also a lower average of early-onset infections among hospitals that did <i>not</i> have prevention policies from 1996-1997, however researchers assessed this decrease as not being statistically significant. </div>
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Take a look at this graph from the CDC,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup> illustrating the number of hospitals that established GBS prevention policies each year between 1989 and 1997.</div>
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The number of hospitals implementing prevention policies began slowly rising, and then skyrocketed in 1996. The curious thing to me is that we don’t see a corresponding skyrocketing decline in GBS rates during this time. Now, after a policy was established, it was presumably carried forward, adding to the total amount of policies overall. So I have assembled a new graph, reformulating the same data to show the total additive amount of hospitals with prevention policies created since 1989 (i.e. every year includes previous years’ values) in conjunction with GBS early-onset rates.</div>
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Look at the rate of change between 1993 and 1999. There is a steady decrease in early-onset infection (the blue line) during this period. However, note that the rate of increase in hospitals with GBS disease prevention policies (the green bar) is not linear - it’s exponential. After the 1996 consensus guidelines were issued, there were substantially more hospitals with prevention policies, and yet this exponential growth was not mirrored by exponential decline in infection rates. Put differently, the rate of decline in GBS early-onset infection is not proportional to the rate of increase in IAP measures, even though the latter is said to have caused the former.</div>
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This discrepancy is all the more curious, given that there was also substantially greater compliance with prevention guidelines in hospitals after 1996.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#40">40-42</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#59">,59</a></sup> So not only were a significant amount of IAP protocols newly established in 1996, but all of the hospital protocols that were already previously in place had supposedly become more effective. </div>
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To illustrate the importance of this, consider that the use of selective broth media when culturing for GBS is 50% more effective than alternative media in identifying GBS<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#60">60,61</a></sup> - the proportion of hospitals using this recommended media increased from 6% in 1994 to 47% in 1997.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup> Similarly, universal screening is said to be over 50% more effective than a risk-based strategy<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#11">11</a></sup> - the proportion of hospitals that screened all women rose from 26% in 1994 to 52% in 1997.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup> Screening at 35-37 weeks of pregnancy yields a colonization status more likely to match that at the time of delivery, compared with screening earlier in pregnancy - the proportion of hospitals that were screening at the recommended time increased from 22% to 65% between 1994 and 1997.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup> And finally, a combined vaginal and rectal culture is 40% more accurate in identifying GBS than vaginal culture alone<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#60">60,62</a></sup> - the proportion of hospitals complying with this recommendation rose from 31% in 1994 to 75% in 1997.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup></div>
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So I am left confused. On the one hand, we have survey data showing hospitals with IAP policies have lower incidence of GBS. On the other hand, there is a mismatch between the linear decline of GBS rates, and the exponential uptake of IAP policies and improved methodology.</div>
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This brings us to a 3rd possible narrative. Namely, that IAP reduces early-onset infections <i>and</i> that early-onset rates are naturally declining on their own - in other words, that IAP is not 100% responsible for the observed decline of early-onset rates, but rather, is enhancing a pre-existing decline. This scenario would mean that current assessments of IAP’s impact are an overestimation, and notably, it could account for the discrepancy between hospital survey data and GBS rates outlined above. Of course, the only way to precisely ascertain the degree of IAP's effectiveness is through randomized controlled trials.</div>
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<span style="text-decoration: underline;"><a name="section8">GBS by Gestation</a></span></div>
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Preterm infants have a considerably higher rate of early-onset infection, compared with full term infants.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9</a></sup> Although IAP is said to be 78% effective in preventing early-onset infection in preterm infants,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> a substantial portion of preterm deliveries among GBS colonized mothers occur without IAP, because colonization status is often unknown at the time of delivery (as a result of not having had the standard 35-37 week culture), and despite CDC recommendations, not all practitioners administer IAP in preterm labors where colonization status is unknown.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> So it can be helpful to analyze GBS trends among full term and preterm infants, separately. </div>
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To that end, early-onset incidence among full term infants has declined, in correlation with IAP. I do not have gestational data prior to 1996, so an assessment of pre-prevention disease trends among full term infants is not possible. There is an interesting spike in the incidence of preterm infants between 2003 and 2007, however no real conclusions can be drawn from this, due to the above referenced challenges of preterm screening.</div>
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<span style="text-decoration: underline;"><a name="section9">GBS by Race</a></span></div>
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There is a disparity in the rates of early-onset infection among whites and blacks, the latter being significantly higher.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#48">48</a></sup> The degree of this disparity has diminished since the advent of IAP,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">64</a></sup> however it continues to persist nonetheless. </div>
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A similar disparity exists with respect to late-onset infection rates as well.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#63">63</a></sup> There are multiple reasons believed to possibly account, or partly account, for this. One is that in the areas under surveillance, blacks have a higher proportion of preterm births than whites.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">39,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">64</a></sup> Since preterm birth carries a higher risk of GBS infection,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> a higher rate of preterm birth would naturally result in a higher rate of overall infection. However, even when we factor preterm births into the analysis, infection rates for full term black infants remain higher than whites.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup></div>
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Another factor is that black women are believed to have higher general rates of colonization.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">39,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#55">55,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">64-66</a></sup> If so, higher colonization rates would be expected to naturally yield more overall infections. In addition, some speculate that disparities in access to prenatal care could account for the racial discrepancy in GBS incidence.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> However, one study found that even when controlling for these variables, black race remained an independent risk factor for disease.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#48">48</a></sup> </div>
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Now, it is interesting to note that incidence among black infants actually increased 70% between 2003 and 2005,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">39</a></sup> during a time when universal screening was in full force, despite comparable screening rates and IAP administration for both black and white mothers.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#63">63</a></sup> This increase persists even when we factor gestational age into the analysis. To that end, both early and late-onset infection among black full term infants rose between 2003 and 2006.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> This increase should give us pause, as it flies in the face of IAP’s presumed efficacy - and even though the increase was only temporary, it speaks to the notion that there are other factors at work influencing GBS incidence. <br />
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While there have also been significant increases in the rates among black and white preterm infants at various points, as mentioned in the previous section, there are too many variables involved with preterm incidence to draw reliable conclusions.</div>
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<span style="text-decoration: underline;"><a name="section10">Late-Onset GBS</a></span></div>
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While the incidence of GBS early-onset infection has decreased dramatically since 1990, rates of late-onset infection (those occurring 7-90 days of life) have remained stable.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9</a></sup> This is to say, IAP (giving antibiotics to laboring women colonized with GBS) has had no appreciable effect on the incidence of late-onset infections as reported from ABCs,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> and there are currently no prevention strategies in place to address it.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,4</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#32">,32</a></sup> This is partly because the GBS bacterium can be acquired post-delivery (e.g. from caregivers), but half of late-onset infections are believed to have a maternal origin at birth,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36,37</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#53">,53</a></sup> which begs the question, why would IAP not have had some impact on late-onset rates?</div>
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Interestingly, a recent study of 322 NICUs between 1997 and 2010 found that rates of GBS late-onset actually increased.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#67">67</a></sup> This increase correlated with the implementation of universal screening, which taken at face value, appears to suggest that IAP is “shifting” some of the burden of neonatal infections into later periods. However, the researchers noted that a portion of the observed increase in late-onset infections may be attributable to the study having included more very low birth weight (VLBW) infants over time. Such infants are more susceptible to infection (having less developed immune systems), and since NICUs in general treat more preterm and VLBW infants compared with other facilities, this could be introducing a bias that is not present within the ABCs dataset. </div>
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That being said, a separate controlled study of full term infants found an association between IAP and late-onset infections.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#68">68</a></sup> And an analysis of late-onset incidence within ABCs found about half of case-infants between 2003 and 2005 were exposed to antibiotics during labor.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> These associations may or may not be indicative of anything, but we have to consider whether it’s possible that ostensibly stable rates of GBS late-onset within ABCs would have been different in the absence of IAP (i.e. that late-onset rates would have declined, but now appear stable as a result of being offset by an increase from IAP, thus masking IAP’s effect).</div>
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Another thing worth noting is that the study of 322 NICUs included urine cultures in their analysis, an important source of neonatal infection in their estimation.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#67">67</a></sup> In contrast, the study of late-onset within ABCs excluded GBS urine cultures from their analysis.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> So this may also play a role in the discrepancy between the datasets.</div>
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Regardless, reported increases in late-onset infection are outweighed by the decreases in GBS early-onset infection. But if IAP is causing an increase in late-onset infections, then obviously this would change the cost-benefit ratio of IAP overall.</div>
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<span style="text-decoration: underline;"><a name="section11">GBS and the Cesarean Complication</a></span></div>
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Cesarean birth does not reduce the risk of GBS infection in newborns.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> However, if a Cesarean is performed before the onset of labor, with intact amniotic membranes, then the risk of neonatal GBS infection becomes negligible and IAP is not recommended.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,4</a></sup> This would likely apply to virtually all of the following situations: 1) Cesareans scheduled in advance by maternal request 2) Cesareans scheduled in advance because of maternal or fetal health concerns 3) Cesareans scheduled in advance by doctor request, in the absence of health concerns 4) repeat Cesareans scheduled in advance because no VBAC (vaginal birth after Cesarean) will be attempted. It’s worth noting that the medical community does not advise electing Cesarean as a means of GBS prevention, because Cesarean birth introduces new health risks that outweigh the initial risk of GBS infection.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#69">69</a></sup></div>
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Now, GBS rates from ABCs are calculated using the total number of live births that occur in the surveillance area. “Live birth” refers to birth of a living newborn via vaginal or Cesarean delivery. But if scheduled Cesareans entail practically no risk of GBS infection, and are not treated within IAP protocols, then we should exclude such births from our calculations of GBS incidence. If we fail to do this, we will end up padding the numbers by including births outside the scope of GBS among the total births from which GBS rates are derived, and this will decrease the resulting rate of infection that gets calculated. So we need to examine how many Cesareans are performed before the onset of labor with intact membranes, how that statistic has changed over time, and whether the resulting figures could potentially distort our evaluation of IAP.</div>
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This is easier said than done, because no one actually knows the percentage of Cesareans that fall into this category. Only information included on birth certificates can be tracked at large by health institutions, and birth certificates do not include whether a Cesarean was scheduled or emergency,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#70">70</a></sup> and ABCs does not collect such information either. So any conclusions to this end are going to be educated estimates, rather than precise figures. Nevertheless, it is worth attempting to sort this out. </div>
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The Cesarean birth rate overall has dramatically increased since the early 1990’s, rising about 60% between 1996 and 2009.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#71">71</a></sup> There is much debate as to why this rate has risen so drastically, but the relevancy to this discussion is that if the subset of Cesareans that are scheduled was the same or larger over time, then this would result in more padding each successive year during this period (all the more so given the number of total births within the surveillance population also increased each year until 2008<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#72">72</a></sup>).</div>
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There are varying estimates on the percentage of Cesareans by maternal request and the percentage of primary Cesareans (women undergoing Cesarean for the first time) without any indicated medical risk.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#73">73-76</a></sup> Some of these estimates conflict, and some are from differing years. But a study of California births in 1995 found that 4.25% of deliveries were attributable to primary Cesareans in the absence of labor.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#77">77</a></sup> With respect to repeat Cesareans, it is not unreasonable to assume a substantial portion are scheduled, given the prevailing “once a Cesarean, always a Cesarean” mentality in the U.S.</div>
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When you factor everything together, I believe it is fair to estimate the percentage of Cesareans without labor or ruptured membranes as accounting for 5% of total births (or 25% of Cesarean births) in the mid 1990s, as some have done.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#10">10</a></sup> It is believed that the proportion of scheduled primary Cesareans has been increasing since 1996<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#75">75</a></sup> - and the proportion of scheduled repeat Cesareans undoubtedly increased between 1996 and 2004 (as the rate of VBACs declined significantly).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#75">75,78</a></sup> So, it’s plausible that by 2009 (the year in which the U.S Cesarean rate peaked) 50% of Cesareans may have been scheduled in advance, which would be 16.5% of all births. Of course, we’re not factoring in those women that go into labor prior to their scheduled Cesarean date, but these scenarios are probably rare enough as to be negligible for our purposes.</div>
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If we proceed using these estimates, we can re-calculate GBS infection rates for 1997-2009 while excluding scheduled Cesarean births from the analysis, and therein get a sense for how this variable might potentially alter our perceptions of GBS incidence over time.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzr-AP38ldaFXfxsEccsf8NnGgGrRrcCRKsoiR5Y9jpCQwPWnXKzec0FiOmJIZtMNsJxbPDwlaNBukYQBcH-7106MvUNzmyYtgajtxbcTXL3sDZtB9CT9-SO_Iq4mX61Ug38q_7jwNnHKG/s1600/08+ZH+-+Early+Onset+-+Cesareans+1997-2009.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzr-AP38ldaFXfxsEccsf8NnGgGrRrcCRKsoiR5Y9jpCQwPWnXKzec0FiOmJIZtMNsJxbPDwlaNBukYQBcH-7106MvUNzmyYtgajtxbcTXL3sDZtB9CT9-SO_Iq4mX61Ug38q_7jwNnHKG/s1600/08+ZH+-+Early+Onset+-+Cesareans+1997-2009.png" height="293" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfEpIKBD5Wg2nKJVA1eLQJ2_jqQqsycJo9KRk1Nln9RVAMYQhwpzlzyknszWfpQ3YNK0zyxFf6oEcmeNauUroM4FhfuPrYi95UwKvVZh2WL_yB6xIa3TuF4JQyCLArmj8W4xflHD8-7u34/s1600/09+ZH+-+Late+Onset+-+Cesareans+1997-2009.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfEpIKBD5Wg2nKJVA1eLQJ2_jqQqsycJo9KRk1Nln9RVAMYQhwpzlzyknszWfpQ3YNK0zyxFf6oEcmeNauUroM4FhfuPrYi95UwKvVZh2WL_yB6xIa3TuF4JQyCLArmj8W4xflHD8-7u34/s1600/09+ZH+-+Late+Onset+-+Cesareans+1997-2009.png" height="273" width="320" /></a></div>
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While these graphs begin at 1997, obviously somewhere between the 1970’s and 1990’s the percentage of scheduled Cesareans was zero, at which point the two lines would overlap. So the effect of including scheduled Cesareans within an analysis of GBS incidence is that the degree of decline in early-onset rates becomes exaggerated. Of course, if the assumptions incorporated into these calculations are underestimations, then the discrepancy observed above would be greater, and vice versa. In addition, a proper analysis would take into account state-specific Cesarean rates and live birth data for each area within ABCs network independently; but my use of national data is sufficient to illustrate the point.</div>
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Although the exaggeration depicted here is not significant enough to fundamentally alter overall trends, it’s certainly a variable that should be taken into account, and one that could become more subversive in combination with other potential fluctuating variables and/or in the event that the proportion of scheduled Cesareans continued to increase.</div>
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<span style="text-decoration: underline;"><a name="section12">GBS False Negatives / Positives</a></span></div>
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Even with perfect implementation, IAP is not expected to be 100% effective, due to some amount of antibiotic failures and changes in colonization status between the time of screening and delivery.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#10">10,14</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#79">,79</a></sup> However, there are reports of unexpectedly large portions of GBS infection occurring in infants whose mothers tested negative for GBS (i.e. false negatives). In a study of early-onset infections from 1997-2003 at a Boston hospital, 82% of the mothers of term infants that acquired infection had negative screening test results.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#80">80</a></sup> Another study of a Tennessee birth cohort found 52.5% of early-onset infections resulted from mothers who screened negative.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#81">81</a></sup> Then in a study analyzing GBS incidence in ABCs 10-state network during 2003-2004, 61.4% of the GBS infections that occurred in full term infants were among mothers who screened negative for GBS.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#49">49</a></sup></div>
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Now, universal screening at 35-37 weeks of pregnancy is said to have a negative predictive value of 96%<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#13">13</a></sup> - that is, 96% of the time if you’re not colonized with GBS at the time of screening, you won’t be during delivery. So the question is if the 4% of negative screening results that we know will be inaccurate accounts for the amount of false negative infections seen in the studies mentioned above. </div>
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To that end, the researchers of the ABCs study calculated the number of infections that would be expected to occur from false negatives - they took 4% of the women who tested negative for GBS, and then applied a rate of infection assumed to transpire in the absence of antibiotic treatment (remember, false negatives do not receive IAP). Accordingly, they expected to see between 44 and 86 cases of infection. The number of such infections that actually occurred was 116 cases. It’s important to note, however, that the researchers assumed a GBS incidence of between 5.1 and 10 cases per 1,000 births in their calculations. As previously discussed, such incidence was the highest among the ranges reported from the 70’s and 80’s. If we instead use lower reports for the calculation, or if we use the 1990 overall incidence of 1.8 per 1,000 (since that rate was before IAP guidelines), then the discrepancy between the expected number of infections resulting from false negative cultures and those that actually occurred would be significantly greater than what was concluded in the study.</div>
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As to why this discrepancy exists, the researchers speculate it may be the result of a combination of factors such as screening more than 5 weeks before delivery (which decreases the accuracy of screening results), or inferior specimen collection, culture processing, and/or errors in the recording of screening results. Regardless, if the assumed negative predictive value of screening is underperforming in practice, it stands to reason that the assumed positive predictive value of screening might also be underperforming in practice. We can’t deduce false positives in the way that we can with false negatives, because false positives only result in unnecessary antibiotics - not infection. </div>
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The positive predictive value (PPV) of universal screening is said to be 87%, which is the figure cited by the CDC and based on a study from 1996.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#13">13</a></sup> However, a study from 2002 concluded that the positive predictive value of GBS screening is lower than that previously suspected - their results showed a PPV of 67%.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#82">82</a></sup> This finding was supported by another study from 2010 also showing a PPV of 67%,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#83">83</a></sup> while a study from 2006 showed a PPV of 52%.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#84">84</a></sup> A systematic review of nine separate studies found an average PPV of 69%.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#85">85</a></sup> These lower PPV’s are perhaps in keeping with a study that showed significant changes in GBS colonization occurred in just a 24 hour period, thus casting doubt on the predictive reliability of 35-37 week screening tests in general.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#86">86</a></sup></div>
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Of course, rapid testing for GBS administered during actual labor would eliminate all of this ambiguity. But the current confusion is relevant because IAP’s perceived success is built around the assumption that the mothers receiving antibiotics are the ones actually colonized with GBS - so if the accuracy of our determinations to that end are in doubt, with evidence showing prior assumptions of positive / negative predictive values to be inflated, then it means there are more colonized women not receiving antibiotics than we thought, and more non-colonized women who are receiving antibiotics than we thought - and this would necessarily change our evaluation of IAP’s performance to date.</div>
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<span style="text-decoration: underline;"><a name="section13">GBS Mortality Rates</a></span></div>
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In full term infants, GBS infection is said to be fatal in 2-3% of cases.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> To be clear, that refers to 2-3% of the 0.5-2% of infants that develop infection from the 10-30% of mothers that are colonized with GBS. Suffice it to say this is a very tiny amount of overall births. In preterm infants, the percentage of fatalities from GBS infection is higher, at 20-30%.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup></div>
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Reports from the 1970’s cited fatality ratios as high as 50%,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44,48</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#61">,61</a></sup> however by 1990 (prior to the IAP era) this amount had drastically declined to 5.8%<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44</a></sup> - this reduction is credited to advancements in the quality of neonatal care.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#14">14,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#61">61</a></sup> From 1990 to 2013, there are many gaps in the mortality data that has been published. I could not find year-specific rates for early-onset mortality between 1991 and 1996. ABCs surveillance reports from 1997 onwards list the number of deaths that occur per year in children less than 1 year of age, but they do not differentiate between early and late-onset, nor between full term and preterm. This makes it difficult to perform a thorough analysis of GBS mortality over time, but the available information is worth examining.</div>
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Given the decline in the amount of early-onset infections in the U.S., logically there should be reductions in the number of deaths resulting from GBS each year (since less overall infections means less potential fatalities). However, since ABCs network expanded between 1990 and 2004 (along with the population in general), this will mean a larger number of births get factored into mortality calculations over time (and more births means more potential infections), which could end up counterbalancing expected declines in the amount of deaths that occur each year. So if we want to properly assess GBS mortality, we’ll need to look at the percentage of GBS infections that result in fatality (i.e. the case-fatality ratio), rather than the absolute number of deaths.</div>
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Here is a graph showing GBS case-fatality ratios, derived from ABCs surveillance reports between 1997 and 2013:<br />
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As you can see, case-fatality has increased since 1997, and has remained mostly stable since the advent of universal screening in 2002. The question is, should this be the case?</div>
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If advances in neonatal care were single-handedly responsible for reducing mortality from 50% to 5.8% by 1990, then presumably any additional improvements to the neonatal care system after 1990 would also result in further declines. Of course, while it seems reasonable to assume that some amount of neonatal care improvement took place during the 23 years between 1990 and 2013, there is no way to objectively confirm this or precisely measure the degree.</div>
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The next thing to consider is, how would we expect mortality rates to behave in the absence of IAP? I would expect that the percentage of babies that die from GBS infection would remain the same without any IAP intervention (assuming equivalent neonatal care)…colonization rates and GBS incidence might fluctuate from year to year, but any acquired infection would presumably entail the same level of severity.</div>
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However, if early-onset rates declined because of IAP, then it seems reasonable to expect that case-fatality would also decline (with or without advances in neonatal care). After all, IAP is eliminating or reducing the population of GBS microbes in the mother, thus preventing the baby from becoming colonized with GBS or otherwise colonized with a lower proportion of the bacterium. So of the babies that still end up developing infection, the level of GBS in their system is less than it would have been in the absence of IAP, and as a result, this would presumably decrease the likelihood that infection would end in fatality. It’s impossible to say how much decline we would expect, but we could reasonably expect some decline to occur.</div>
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Nonetheless, the case-fatality ratio in 2013 was the same as it was in 1990, and this doesn’t seem to comport with expectations from IAP or improvements in neonatal care. This raises an interesting question - is it possible that IAP is increasing the severity of infection? This could potentially occur if the GBS bacteria that survive the onslaught of IAP go on to create a more antibiotic resistant colony in the newborn. Such would account for the discrepancy between expected declines resulting from neonatal care advancements and IAP, and observed case-fatality rates. It could also account for why GBS case-fatality appears to have declined between 1990 and 1997 (reaching a low of 2.6%),<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#35">35,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#72">72</a></sup> before steadily climbing back up between 1997 and 2002 (the period of transition to widespread adoption and implementation of IAP<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36,</a>).</div>
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It must be noted that this analysis is limited by a variety of information gaps. The case-fatality trends in the above graph combine early and late-onset, and they do not assess the proportion of preterm births for each year - if there were increases in the proportion of preterm births within the surveillance population over time, this could inflate overall mortality figures (since preterm births are more prone to GBS fatality<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup>). In addition, there could be cases of infection / fatality between 90 days and 1 year embedded in the ABCs data used to calculate the above figures (although any amounts therein would very likely be negligible). At the same time, we don’t know if 100% of the cases reported by ABCs for the years above had complete data (sometimes outcomes, gestational age, etc are not known for all reported cases of infection), so these calculations constitute a minimum estimation.</div>
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However, there is a population-based study of the ABCs network between 1990 and 2005, which found that late-onset mortality was lower in the era of universal screening (after 2002) than before the advent of IAP (prior to 1996).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup> But note from the graph above that overall case-fatality temporarily decreased between 2002 and 2005, before significantly increasing in the years afterward - so it’s possible the findings of this study reflect a temporary association that was about to change. Regardless, if the case-fatality ratio of late-onset within ABCs decreased after 2002, while the overall case-fatality remained stable on average, then by deduction case-fatality for early-onset would had to have increased. This is in fact apparent in data from population surveillance for the specific years 1990 and 2004,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#32">32,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44</a></sup> data which is robust enough to offer a thorough comparison between the pre-prevention era and the IAP era. Take a look at the following chart:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvyj5Xg1UYSibO7mnBJnnVaABiIFEq0LoTWcfK5dSSpvzYp1klf2cER-ZZfRlsVWdiDAYU96IfUi-Ez2F99sWENcBVLhzOw6Ab05hD309Uk0ue2u3Pb7N34M15QivJgTMZbdmZpGEjEoQy/s1600/11+ZH+-+Mortality+1990+and+2004.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvyj5Xg1UYSibO7mnBJnnVaABiIFEq0LoTWcfK5dSSpvzYp1klf2cER-ZZfRlsVWdiDAYU96IfUi-Ez2F99sWENcBVLhzOw6Ab05hD309Uk0ue2u3Pb7N34M15QivJgTMZbdmZpGEjEoQy/s1600/11+ZH+-+Mortality+1990+and+2004.png" height="237" width="320" /></a></div>
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The overall case-fatality was higher in 2004 (when universal screening was in full effect) compared to 1990. Early-onset case-fatality was higher in 2004 than 1990. When we look at preterm births, case-fatality in 2004 was almost 3 times higher than in 1990. Late-onset mortality was lower in 2004 than 1990 (outweighed by the aforementioned increases). We still need to consider the possibility that 2004 had a higher proportion of preterm infections, which could have inflated it’s overall mortality - to that end, the percentage of deaths that were preterm was 80% in both years, and of the total GBS infections in each year (with complete data), 1990 had a higher proportion occur in infants less than 37 weeks gestation…and yet, 1990 still has a lower overall case-fatality compared with 2004. I find this remarkable. <br />
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All together, it appears to suggest that while IAP may be decreasing the amount of GBS early-onset infections, it may be increasing the severity of the remaining infections that occur.</div>
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Interestingly, the study of 322 NICUs between 1997 and 2010 mentioned earlier in this article found increases in the mortality rate associated with both GBS and E. coli late-onset infection after universal screening was implemented in 2002 (increases of close to 50%), with stable mortality rates for early-onset.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#67">67</a></sup> The researches speculate that improved survival of VLBW (very low birth weight) and preterm infants over time may be making them more susceptible to infection in the late-onset period. However, while this may explain increased incidence of infection among VLBW and preterm infants, it’s unclear whether it would explain the increased percentage of fatalities resulting from those infections. As I see it, if better neonatal care is allowing more VLBW and preterm infants to survive, then we should expect those same improvements in neonatal care to contribute to saving more of those babies that acquire infection (which would reduce the case-fatality ratio). The fact that we don’t see this confuses me, and again speaks to the possibility of some kind of biologic or selective pressure at work, which is perhaps increasing the virulence of surviving microbes. </div>
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Lastly, it’s also worth mentioning a study which found that when antibiotics were universally administered to neonates at birth (as an alternative strategy to IAP), overall neonatal mortality increased by 40% despite a 68% reduction in the rate of infection.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#79">79</a></sup> Newborns are obviously exposed to IAP through placental transfer, so perhaps the mortality increases discussed in this section are in keeping with this study’s findings. </div>
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In the end, everything we’ve examined here seems to point toward a net increase in case-fatality rates of one kind or another, and so I am left with the impression that IAP reduces the quantity of infections at the expense of increasing infection severity.</div>
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<span style="text-decoration: underline;"><a name="section14">GBS at the State Level</a></span></div>
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The GBS infection rates we have examined so far are representative of the entire ABCs network. However, in combining data from multiple sources, there is the risk that averaging overall incidence can mask anomalous findings within isolated sites. So it seems wise that we also examine state-specific GBS infection rates. Of course, incidence within an isolated area is not a reliable predictor of national trends, but that is not the goal - we’re interested in assessing the effectiveness of IAP in the absence of reliable clinical research. To that end, if antibiotics effectively reduce early-onset GBS infection, they should do so regardless of the location in which they are administered. So the ABCs network can be viewed as a collection of separate regions testing the protocol independently, and we should see early-onset rates declining within each respective region in correlation with IAP.</div>
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There are two obstacles to this plan. 1) Only a few of the 10 states that comprise ABCs network were tracking GBS prior to 1995. However, seven states were tracking GBS from 1996 onwards, which may be of use in assessing the impact of universal screening guidelines. 2) There is no published study that comprehensively examines GBS incidence within each ABCs area for the entire respective history of surveillance - there are only a handful of studies that list state-specific rates, from which such an analysis can be conducted solely with respect to early-onset incidence between 1998 and 2005.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#32">32,35</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">,39</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">,64</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#87">,87</a></sup></div>
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Some states have published GBS data online, however much of the information is limited. I inquired with the CDC as to how to obtain comprehensive state-specific rates, and they said I would need to contact each state’s health department or Emerging Infections branch.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#88">88</a></sup> Accordingly, I have been in communication with 7 of the states with limited information, but my efforts have been met with very little success - this is mostly due to the fact that these offices are immersed in important workloads and busy schedules, and simply can’t spare the time to facilitate my request…of course, conducting this inquiry as a regular citizen unaffiliated with any institution doesn’t exactly help matters.</div>
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In my conversations with a few ABCs coordinators, I was surprised to learn that not all states are in possession of their own data. I took it for granted that each ABCs state already had comprehensive GBS data specific to their region, and that it was just a matter of getting them to supply me with this information. However, as it turns out, this is not the case - such information would need to be manually calculated for the first time, requiring the devotion of staff and resources. It is baffling to me that any agency involved in tracking a disease would not by default have comprehensive internal records of that which they are tracking, but it seems that such information is simply sent to the CDC for integration. Even still, one would think the CDC would possess compartmentalized records of each surveillance area’s findings, but apparently they either don’t, or otherwise did not wish to share such information with me.</div>
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I also got the sense that state-specific trends are generally viewed as unimportant, because the sites are collectively held to be representative of the country, and since assessing national incidence is the main goal of the CDC, isolated trends are essentially irrelevant. However, this is extremely shortsighted in my opinion, because if you don’t look at state-specific trends, then you can’t ascertain whether a single site (or subset of sites) is disproportionately influencing the overall trend, nor can you ascertain whether all sites are conforming to national expectations. Of course, even if a site did depart from national trends, there could be a variety of reasons accounting for why that is - but it seems obvious that we should be in a position to know if / when such departures occur, in order to be able to investigate them further.</div>
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So with all of that being said, let’s examine some limited state data I have been able to assemble. Minnesota and Colorado both seem to comport with national trends.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh17M0WA5DRSrUGBCopu_YJjbhtB2S05tjwpIo1hB_Lq97_uUzuCIW_4C0kexnpQSUC09BfOQy8cabU5bwLxKvEAzu5qWdFZp-gA2rjRxJh0XUHuUTRQyVIkgbmTSU2yyXJdmCn9d9CE5Y7/s1600/12+ZH+-+Minnesota+1998-2013.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh17M0WA5DRSrUGBCopu_YJjbhtB2S05tjwpIo1hB_Lq97_uUzuCIW_4C0kexnpQSUC09BfOQy8cabU5bwLxKvEAzu5qWdFZp-gA2rjRxJh0XUHuUTRQyVIkgbmTSU2yyXJdmCn9d9CE5Y7/s1600/12+ZH+-+Minnesota+1998-2013.png" height="172" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjftATtW7zTWWtNzb2GCLexB78gwlIzln5MTUfOJACxW9ekeJUgNOZmEQnDF5Pxvxj1Fx8-FdOUA8x0lRayPsC51JUWqIEvAogoG2DTYbi9RtpcQl6FGySTCjaNGZTiS04Dl_B1LPbKltyk/s1600/13+ZH+-+Colorado+2001-2013.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjftATtW7zTWWtNzb2GCLexB78gwlIzln5MTUfOJACxW9ekeJUgNOZmEQnDF5Pxvxj1Fx8-FdOUA8x0lRayPsC51JUWqIEvAogoG2DTYbi9RtpcQl6FGySTCjaNGZTiS04Dl_B1LPbKltyk/s1600/13+ZH+-+Colorado+2001-2013.png" height="167" width="320" /></a></div>
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On the other hand, in Connecticut it appears that universal screening has had no impact on early-onset infections. There was a temporary dip in 2004, but by 2007 rates had increased higher than they were in 2001.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxSqMbNop5b9XFDu6AYy75LDvwe0vUmIyC_n4L3QGYXHBqh_u7QPwV5i-N9jwb0_jMBiu6dGAI9kfrCvFcEfrxC8mxmmc7V1XPJp-qWo0TdT0gzFuqg0fWt1nJnypZjBxaoUAtqeY6j_R/s1600/14+ZH+-+Connecticut+1996-2011.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxSqMbNop5b9XFDu6AYy75LDvwe0vUmIyC_n4L3QGYXHBqh_u7QPwV5i-N9jwb0_jMBiu6dGAI9kfrCvFcEfrxC8mxmmc7V1XPJp-qWo0TdT0gzFuqg0fWt1nJnypZjBxaoUAtqeY6j_R/s1600/14+ZH+-+Connecticut+1996-2011.png" height="145" width="320" /></a></div>
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The impact of universal screening in Oregon is ambiguous, with no sustained effect apparent: </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6AjMzNnrWUmewGmrGixt51TWfo8wGe4Hg5reVx-bBDiSHwH2CkehD76VZkhnj2J_47yqWrqoI2ttQ1hBaWBWL0pNLp2ZXxKFzzsKFHpK8wAsDBtUcM5L1e7gJBCbZdb3pHyUZYrB4lxW7/s1600/15+Oregon+1996-2011.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6AjMzNnrWUmewGmrGixt51TWfo8wGe4Hg5reVx-bBDiSHwH2CkehD76VZkhnj2J_47yqWrqoI2ttQ1hBaWBWL0pNLp2ZXxKFzzsKFHpK8wAsDBtUcM5L1e7gJBCbZdb3pHyUZYrB4lxW7/s1600/15+Oregon+1996-2011.png" height="149" width="320" /></a></div>
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With respect to the remaining states, the available information regarding early and late-onset infection is too limited to be useful, in my opinion. </div>
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Now, it’s possible that the speed and degree of compliance with national guidelines might have varied in each state, and that this might explain the apparent lack of impact of universal screening on early-onset rates within Connecticut and Oregon. However, based on a CDC analysis of per-state compliance before and after their 2002 guidelines, it is evident that this cannot account for the discrepancy observed, because adoption and implementation of universal screening within CT and OR was optimal.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup></div>
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There is some additional per-state hospital data that is intriguing. Take a look at this graph published by the CDC,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#41">41</a></sup> comparing the relationship between the proportion of hospitals with GBS prevention policies and corresponding infection rates, per state.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq1kbBxJ-RVf3hnXgFaeMYl_a9bVS8sfBXT8MnZGZ7tny49aTdVPlETgMxb2enxXs_gRswHEx1zNusQdIobeL-KvJepWqTF_UuuJStpAXxv3IbhwRUNgOfQIKuQ-6InC_b6pRkZ6TvtlGi/s1600/16+Hospitals+with+GBS+prevention+strategies+(MMWR%2B1998%3A47).png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq1kbBxJ-RVf3hnXgFaeMYl_a9bVS8sfBXT8MnZGZ7tny49aTdVPlETgMxb2enxXs_gRswHEx1zNusQdIobeL-KvJepWqTF_UuuJStpAXxv3IbhwRUNgOfQIKuQ-6InC_b6pRkZ6TvtlGi/s1600/16+Hospitals+with+GBS+prevention+strategies+(MMWR%2B1998%3A47).png" height="284" width="320" /></a></div>
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What is immediately apparent is that the state with the most prevention polices (CT) has the lowest rate, and the state with the least prevention policies (TN) has the highest rate. But now take a closer look at the middle section of the graph, and notice that Georgia and Minnesota have equivalent prevention polices, yet drastically different infection rates. Also note that Oregon has a higher amount of prevention polices than Minnesota, yet also has a higher rate of infection. And finally, note that Minnesota and Maryland have fewer prevention polices than California and Connecticut, yet comparable incidence.</div>
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So within the limited data we have examined, not everything is adding up.</div>
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There is one more item which I should mention, as it’s quite peculiar. Georgia’s health department has published data on GBS in which early-onset rates are listed between 1994 and 2007.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#89">89</a></sup> What’s curious, however, is that none of the rates match the figures separately listed by the CDC in connection with Georgia, despite the fact that the source for both is supposedly ABCs. What makes this all the more curious is that Georgia’s self-published graph shows early-onset rates were increasing from 1995 to 1999, as well as between 2003 and 2007.</div>
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This increase is not mirrored in the limited data published by the CDC.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#32">32,35</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#39">,39</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">,64</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#87">,87</a></sup> I do not know what to make of this, as I find it hard to believe that either party could be in error. </div>
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Nonetheless, Georgia’s publication explicitly states that the reduced incidence of early-onset observed in U.S. national data is not apparent within their state. The publication speculates that the state’s increase could be a result of improved case-ascertainment stemming from expanded state-wide surveillance (which began in 2004) and audited surveillance (which also began in 2004 according to this document). </div>
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However, if the expansion of Georgia’s surveillance network resulted in better detection and thus, higher reported incidence, then we would expect to see the same phenomenon occur within ABC’s network overall…which of course, we don’t. Plus, the rising rates within Georgia’s publication occur within consistent surveillance periods (as opposed to rates jumping up only when the surveillance area expands). In addition, while Georgia states that audited surveillance (which is said to improve the accuracy and yield of infection cases) began in 2004, it has been reported elsewhere that audited surveillance in Georgia was occurring as early as 1990,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#44">44</a></sup> and ABCs claims to regularly audit surveillance in all of their territories.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#64">64,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#72">72</a></sup></div>
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So I am quite confused. I planned on getting to the bottom of this by contacting Georgia’s Emerging Infections branch to submit a data request for GBS rates and/or speak with the ABCs or GBS coordinator. However, it turned out this was easier said than done. After days of getting bounced around from place to place, I was unsuccessful in finding the appropriate office, and bizarrely, no one in the health department knew who oversaw this issue. Eventually, a data coordinator at the health department contacted the State Epidemiologist for guidance on my inquiry, and many weeks later I am still standing by. So for now, make of this what you will.</div>
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<span style="text-decoration: underline;"><a name="section15">GBS Around the World</a></span></div>
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Exposure to GBS is said to be similar throughout the world among pregnant women, in developed and developing countries.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#12">12</a></sup> Colonization runs the gamut, with reported rates between 1.6% and 36% depending on the region and year.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#19">19,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#90">90</a></sup> In general, GBS incidence is said to be lower in countries and hospitals that implement some form of IAP protocols, compared to those that do not.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#91">91,92</a></sup> Early-onset infection rates have declined, in correlation with IAP, in Canada,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#93">93,94</a></sup> Spain,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#95">95</a></sup> France,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#96">96</a></sup> and Australia,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#97">97-99</a></sup> which have adopted prevention strategies similar to the U.S.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9</a></sup> Needless to say, when the same exact correlation pops up independently in separate countries, a causal relationship becomes more compelling.</div>
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But as with the United States, things are not so straightforward. There is limited GBS data available in Europe,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#100">100</a></sup> and it appears many countries were not actively tracking GBS until around the time IAP began to be administered or guidelines were issued,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#101">101,102</a></sup> thus preventing a comprehensive analysis of disease trends starting before IAP. Furthermore, many international studies of GBS incidence stem from single hospital reports,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#103">103-106</a></sup> and may not be adequately representative. Amusingly, researchers concluded in one Australian study that IAP was the likely cause of GBS declines because early-onset infections from non-GBS pathogens also declined<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#97">97</a></sup> - by this logic, IAP would not be responsible for GBS declines in other countries (such as the U.S.<sup style="font-size: 9px; line-height: 8px;">3</sup>) where no such decline in non-GBS incidence occurred. </div>
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With respect to Spain, an interesting curiosity was brought to light in a study of hospitals, which analyzed GBS incidence after prevention guidelines were established.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#101">101</a></sup> Hospitals were grouped according to the year in which prevention guidelines were adopted: on or before 1998, and 1999. Rates decreased in both groups after prevention guidelines were implemented, consistent with IAP’s effectiveness. However, each group had differing degrees of decrease - rates declined 65% in the 1998 group, and 36% in the 1999 group. Also interesting is that incidence of E. coli decreased in the first group (the group with greater GBS decline), but increased in the second group. Lastly, sepsis mortality rates significantly decreased in the first group, but not for the second group. This suggests to me that other important and relevant factors are at work, potentially skewing our evaluation of IAP.</div>
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In the U.K. and Republic of Ireland, where systematic screening is not practiced and IAP rarely administered,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#107">107</a></sup> GBS early-onset infection rates have been .5 per 1,000 live births.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#19">19,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#107">107,108</a></sup> This is markedly lower than what we would expect based on U.S. assumptions, and is comparable to the incidence among countries that implement universal screening.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#94">94</a></sup> Some suspect the U.K. rate is a result of underreporting and/or differences in colonization rates,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#107">107</a></sup> but there is no sufficient data to support or refute such assertions. Interestingly though, the incidence of late-onset infections in the U.K. and Ireland between 1996 and 2004<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#12">12</a></sup> was basically equivalent to the rate of incidence reported in the U.S. during the same period<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36</a></sup>…if differences in colonization between the U.S. and U.K. were responsible for the differences in early-onset rates, then presumably one would expect to see differences in the rates of late-onset as well. </div>
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Some assert that incidence in England, Wales, and Northern Ireland has been rising since 2003 and that therefore universal screening should be adopted in the U.K.,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#109">109</a></sup> however such claims are based on the total number of case reports per year, and thus misrepresent the true disease burden by not accounting for fluctuations in the birth population. When analyzing rates per 1,000 live births, incidence of early-onset infection in these regions was identical in 2003 and 2013 (.37 and .38 respectively).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#110">110,111</a></sup> On the other hand, rates of late-onset did increase during this period (from .18 to .23),<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#112">112</a></sup> but since no IAP protocol has ever been associated with decreased late-onset infection, it is reasonable to ask whether IAP is having unintended consequences in the late-onset period.</div>
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In Finland, overall neonatal GBS incidence (early and late-onset combined) declined from 3 per 1,000 to .76 per 1,000 live births between 1976 and 1994, in the absence of a universal screening policy or national guidelines.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#113">113-115</a></sup> From 1995-2000, during which IAP was not routinely administered, early-onset was .6 per 1,000 live births,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#103">103</a></sup> comparable to the U.K.</div>
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Norway adopted a risk-based prevention strategy in 1998, after rates had been climbing from 1985 throughout the 1990’s.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#117">117,118</a></sup> The impact of their prevention guidelines is somewhat unclear, but it seems that early-onset rates were stable overall before and after their implementation (with late-onset increasing in 2005 and 2006).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#116">116,119</a></sup> Curiously, the country experienced an unexpected and quite significant spike in GBS mortality in 2006, for reasons unknown.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#116">116,220</a></sup> </div>
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The Netherlands also established risk-based guidelines in 1999, but although rates initially decreased after it’s implementation,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#121">121</a></sup> a subsequent national surveillance study conducted to assess the impact of prevention protocols found that they did not lead to decreased incidence among newborns. Rates were analyzed over a 25 year period between 1987 and 2011, and incidence was higher in the period after protocols were implemented.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#122">122</a></sup></div>
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Then there’s Israel, India, and Greece, three countries in which incidence is remarkably low in the absence of prevention guidelines, with reported rates between .1 and .3 per 1,000 births.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#123">123-126</a></sup> Overall incidence in the region of Southeast Asia has been reported as low as .02 per 1,000 births.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#91">91</a></sup> A study of women in Zimbabwe actually found that colonization was not even associated with adverse outcomes (i.e. infection).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#125">125</a></sup> And incidence within developing countries is generally lower than developed countries,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#12">12,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#92">92</a></sup> though there are some exceptions.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#91">91</a></sup> </div>
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Reasons speculated for the aforementioned discrepancies include differences in maternal colonization rates, differences in the virulence of GBS strains and serotype distribution, and differences in clinical diagnosis, however all of these speculations can be refuted by the available evidence.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#128">128</a></sup> Other potential reasons include differences in the quality of surveillance, genetic differences among populations, and differences in the levels of maternal protective antibodies acquired by newborns.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#12">12</a></sup> A compelling case has been made that factors relating to inherent immunity among mother and fetus play a crucial role in explaining why such a small percentage of newborns are susceptible to GBS infection in the first place, why it’s higher in preterm infants, and why some regions have lower incidence despite relatively high rates of colonization.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#129">129</a></sup></div>
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<span style="text-decoration: underline;"><a name="section16">Risks of IAP</a></span></div>
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All of the confusion outlined in this article makes it impossible to definitively ascertain IAP’s effectiveness and overall worth. IAP might work as claimed…or it might not. Of course, most practitioners in the U.S. undoubtedly believe that IAP is effective, but such assurance appears to be based on habit alone. The dilemma becomes all the more pressing in light of the fact that the use of antibiotics is not completely risk free.</div>
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The most extreme risk of IAP is that of maternal anaphylactic shock, which has been documented in response to penicillin (the primary antibiotic used during IAP)<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#130">130-132</a></sup> and cefazolin (a secondary alternative).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#133">133</a></sup> Women with an allergy to penicillin are obviously given alternative antibiotics, however, one documented case of maternal anaphylaxis (which led to fetal demise) occurred despite the absence of such an allergy.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#134">134</a></sup> However, it must be stressed that anaphylaxis is extremely rare.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,4</a></sup> According to the CDC, about 1 in 10,000 mothers will experience severe allergic reaction.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#135">135</a></sup> Fatal anaphylaxis has been estimated at 1-4 per 100,000<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#136">136,137</a></sup> (although some feel this estimate is grossly inflated<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#107">107</a></sup>). Regardless, the incidence of maternal anaphylaxis is significantly more rare compared to the incidence of GBS infection, and thus IAP’s reduction of the latter is considered to outweigh the occurrence of the former.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> </div>
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IAP also has been associated with increased incidence of maternal and neonatal yeast infection.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#128">128</a></sup> Yeast infection of the breast can dissuade some mothers from breastfeeding their infants.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#139">139</a></sup> Other milder reactions to antibiotics include rash, which occurs in 0.7-4% of penicillin treatments.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup></div>
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Increasing resistance of bacteria to antibiotics is a major concern in the health community, and this concern extends to IAP protocols. GBS resistance to erythromycin, clindamycin, and ampicillin following the implementation of IAP have been documented,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#68">68,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#90">90,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#140">140,141</a></sup> as well as E. coli resistance to ampicillin,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#142">142-146</a></sup> however no resistance has yet been observed in penicillin.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#4">4,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#14">14,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#36">36,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#68">68,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#90">90</a></sup> That being said, there has been increased penicillin resistance among non-GBS pathogens throughout the world,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> so perhaps it is simply a matter of time before we see the same with GBS, and to that end there are limited initial reports of reduced GBS susceptibility to penicillin in Hong Kong and Japan.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#147">147,148</a></sup> </div>
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There is also concern that while IAP may be decreasing the rate of GBS infection, it may be increasing the rate of infection from non-GBS pathogens. Some studies have demonstrated this with respect to E-coli (particularly among very low birth weight infants)<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#67">67,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#140">140,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#146">146,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#149">149-152</a></sup> and late-onset infection from gram-negative pathogens other than E. coli,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#145">145</a></sup> however other research disputes this.<sup style="font-size: 9px; line-height: 8px;"><span id="goog_425961369"></span><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,14</a><span id="goog_425961370"></span><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#98">,98,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#153">153</a></sup></div>
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In general, IAP reflects a philosophy of care that has become standard, in which antibiotics are overprescribed and widely administered as a preventative measure. Such practices are a primary factor in increasing antibiotic resistance among microbes.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#154">154</a></sup> When an antibiotic is administered, it doesn’t target one specific bacterium, nor does it affect one isolated location. Rather, there are a variety of bacteria that are susceptible, over and above the “bad” bacteria for which the antibiotic has been prescribed, and after an antibiotic enters the bloodstream it gets circulated throughout the entire body, eliminating susceptible bacteria everywhere (both “good” and “bad”).<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> So antibiotics aren’t snipers; they’re bombers. </div>
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This must be appreciated because the more we use antibiotics, the more we select for resistance in the overall bacterial population; i.e. those bacteria with resistant genes that survive an antibiotic onslaught go on to reproduce, which leads to more bacteria with such resistance.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#154">154</a></sup> As this compounds, antibiotic resistance increases, which makes them less and less effective. The more bacteria susceptible to a given antibiotic, the greater the selection for resistance will be.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> Thus, we want to be diligent about our use of antibiotics (particularly broad spectrum antibiotics) and guard against their excessive use so that we don’t facilitate, expedite, and/or exacerbate the creation of “superbugs”, which puts everyone at greater risk of acquiring life-threatening antibiotic-resistant infections. Additionally, we want to limit the likelihood that small and rare colonies of bacteria (what Dr Martin Blaser refers to as “contingency species” in his book <i>Missing Microbes</i>) will become permanently wiped out from any given antibiotic exposure, as the absence of such species decreases our microbial diversity, which ultimately makes us more vulnerable to future potential pathogens.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup></div>
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Given the low incidence of GBS infection and the uncertainty regarding when infection will occur, the current IAP strategy necessitates treating a great many so as to save a tiny few, which results in multitudes of women receiving antibiotics who don’t actually need them. And while penicillin G (the preferred choice for IAP) is narrower in scope compared to alternative options,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#3">3</a></sup> it nevertheless kills a variety of bacteria over and above GBS.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#156">156</a></sup> So about a million mothers will receive antibiotics each year, in our attempts to prevent roughly 6 thousand babies from acquiring infection.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#37">37</a></sup> But of course, antibiotics administered to laboring women also engage their babies via placental transfer, which means about a million newborns are exposed to antibiotics each year through IAP as well. Of course, 6 thousand neonatal infections is something to take seriously, but so is 2 million exposures to antibiotics.</div>
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This becomes particularly relevant in the context of a newborn baby’s microbiome, which begins forming during birth. Prior to labor, the baby is essentially a blank slate, bacteriologically speaking.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#2">2</a></sup> As the baby moves through the vagina during birth, fundamental microbes are picked up. Additional microbes are then picked up from the mother’s skin, rectum, and the surrounding birth environment. Then more through the breast milk, the initial feeding of which typically takes place within the first hour after delivery. All of this colonization is essential to a healthy infant,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#155">155</a></sup> and importantly, the species of bacteria picked up by newborns are not random, but the result of coordinated changes in the microbiomes of mothers that occur throughout pregnancy.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup></div>
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There is thus concern that IAP may undermine the acquisition of this founding wave of microbes. The antibiotic, which is administered at regular intervals every four hours, kills both GBS and non-GBS bacteria in the mother.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#156">156</a></sup> So the question is what are the consequences of this? Unfortunately the data is scant. There have been some studies showing IAP altered the gut microbes of infants when penicillin, ampicillin, and gentamicin were utilized,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#157">157,158</a></sup> and the same has been found with respect to general antibiotic exposure in the first days of life,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#159">159</a></sup> but no studies have investigated the longterm implications of this<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#159">159</a></sup> (if indeed there are any). There has, however, been some such research with respect to Cesarean births, and since Cesarean delivery bypasses the biologically designed processes of newborn colonization (through both surgical delivery and antibiotic administration), it very well may be a useful guide with respect to IAP. </div>
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To that end, it has been shown that the gut microbes of babies born via Cesarean section lack species normally acquired during vaginal birth,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#160">160</a></sup> and have differing distributions of colonized bacteria,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#155">155,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#159">159,161</a></sup> and this alteration has been associated with an increased risk of certain health conditions such as asthma, obesity, celiac disease, and allergies.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,2,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#162">162,163</a></sup> To be clear, Cesarean delivery in no way guarantees that infants will acquire such maladies, but the point is that this increased risk is a direct result of alterations to the microbiome. Although the microbiomes of Cesarean and vaginally born babies do begin to converge over time,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> these initial alterations can impact the future health of individuals by modulating the distribution of microbes moving forward, as one study found a significant difference in the gut microbes of 7 year old children born vaginally and via Cesarean.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#164">164</a></sup></div>
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It’s reasonable to question whether IAP may have similar effects. In general, research shows that antibiotic exposure at young ages increases the propensity to become obese and develop asthma,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> and antibiotic exposure in utero has been linked to asthma, eczema, and hay fever.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#165">165</a></sup> The use of penicillin in labor has also been associated with a 2.6-fold increase in respiratory distress among GBS colonized newborns.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#166">166</a></sup> While the microbiome in some babies may end up compensating or making up the gap eventually, this may not be the case for other babies, and even if IAP alterations are only temporary, they nevertheless are occurring during a critical window in newborn development,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#155">155</a></sup> the consequences of which need to be thoroughly evaluated.</div>
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What we can say for certain is that the microbiome matters, that birth is the genesis of it, and that IAP has some effect on its formation. This is an area where research is ongoing, but one that must be factored into any cost-benefit analysis of current GBS protocols.</div>
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Ultimately, if we’re going to expose families and society to the risks of antibiotics, whatever they may be, then we better make sure the treatment actually does what we think it does. Only then can one make the value judgement that the rare amount of newborn GBS infections avoided through treatment outweigh the rarer amount of maternal anaphylaxis resulting from treatment, that the benefits of reducing GBS incidence are worth the risks of fostering antibiotic resistance, and that altering the microbiome of a million babies is acceptable in order to prevent GBS infection in a few thousand babies. Of course, for those prepared to make the aforementioned value judgements, the limitations of IAP research would appear to make it difficult to do so with confidence.</div>
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<span style="text-decoration: underline;"><a name="section17">Alternatives to IAP</a></span></div>
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The most discussed alternative to IAP would be a GBS vaccine, the need and usefulness of which has been cited many times throughout GBS literature. Research and development has been underway for many years and clinical trials are ongoing.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9,12</a></sup> In comparison to IAP, there are many benefits to a GBS vaccine, along with some drawbacks.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#9">9</a></sup> Regardless, it is not yet available as an option.</div>
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Another alternative strategy implemented by some practitioners is the use of probiotics. The intent here is to effect a microbiome in which GBS is decreased and/or replaced by alternative bacteria, thus circumventing the entire GBS dilemma. Scientific research on probiotics is generally limited,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1,</a><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#159">159</a></sup> but there is a clinical trial currently underway researching its application to GBS,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#167">167</a></sup> so the jury is out. Still, given the general lack of harm involved with probiotics,<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#1">1</a></sup> some find it prudent to take them despite the lack of clinical data. If they are effective, it would make sense to take them early in pregnancy regardless of GBS status, so as to allow maximum time for the probiotic to build up in the system by 37 weeks.</div>
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<span style="text-decoration: underline;"><a name="section18">GBS Conclusions</a></span></div>
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From my perspective, looking in from outside the medical community, there appears to be a double standard in the way that GBS research gets interpreted and discussed. Declining incidence among countries with prevention strategies is assumed to be attributable to IAP, while increasing incidence among such countries is assumed to be attributable to compliance failures. Low incidence in countries with universal screening is assumed to reflect the efficacy of IAP, while low incidence in countries without universal screening or without routine IAP is assumed to reflect underreporting and/or differences in colonization or virulence. Fundamental assumptions are rarely (if ever) questioned, and contradictory findings typically go without mention. In bizarre fashion, the clinical trials that spearheaded the IAP era, the quality and reliability of which were harshly criticized by the Cochrane Collaboration, routinely get cited as if beyond reproach.</div>
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I am troubled by the general lack of concern that I have encountered over the issues discussed in this article. Many are dismissive of the Cochrane analysis, and many feel the observed correlation between IAP and GBS rates in the U.S. is sufficient evidence by itself. But we cannot rely on correlation alone just because it tells us what we want to hear, and the discrepancies outlined above warrant careful consideration.</div>
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Although the likelihood of modern trials appears to be nonexistent, it might be within the realm of possibility among countries without IAP protocols, or those without universal screening guidelines. There could also potentially be useful information gleaned from a study of GBS among homebirths or birthing centers - such families may be more likely to decline antibiotics than families planning to birth in a hospital, which might yield sizable treatment vs no-treatment comparison groups. To that end, the Midwives Alliance of North America (MANA) compiles and maintains a statistics registry of health data in which a retrospective analysis of this nature would be possible.<sup style="font-size: 9px; line-height: 8px;"><a href="http://zackhemsey.blogspot.com/2015/03/the-puzzling-case-of-gbs.html#168">168-171</a></sup></div>
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In the meantime, families contending with GBS find themselves in a difficult position. Assessing the risk of developing GBS infection against the pros / cons of IAP is not a straightforward evaluation, and comes down to one’s personal perspective. Some are uncomfortable with the idea of receiving antibiotics during labor, but the pressure to acquiesce to prevention protocols can be extreme. Of course, when doctors strongly recommend treatment with unwavering conviction for the safety of the child, it is not surprising that most women agree to receive them. This is unfortunate, as health recommendations and decisions should be informed by science, and not based in assumptions, intimidation, and/or exaggerated fear. Equally unfortunate is the vitriol encountered by families that choose to decline antibiotics - it is quite remarkable how such families can be vilified, despite the uncertainties in the research.</div>
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In the end, if the medical community is going to continue recommending that laboring women receive antibiotics as a routine preventative measure, then I would argue they have a moral obligation to acquire reliable clinical evidence of its efficacy. And if / when we subsequently confirm IAP is as effective as currently believed, such will not end the conversation or debate as to whether IAP strategies are ultimately in the best interests of society…but at least we would have a valid discourse to that end, based on known effectiveness and not presumed effectiveness.</div>
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<a name="1"><b>1 </b></a>Blaser, M. (2014). Missing Microbes. New York: Holt, Henry & Company.
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<a name="2"><b>2 </b></a>Neu J, Rushing J. Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011 Jun; 38(2): 321-331.
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<a name="3"><b>3 </b></a>CDC. Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC, 2010. MMWR Recommendations and Reports: 2010; 59 (RR-10) (November): 1–32.
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<a name="4"><b>4 </b></a>Remington JS, Klein JO, Wilson CB, Baker CJ. Infectious Diseases of the Fetus and Newborn Infant (Sixth Edition). Arch Dis Child Fetal Neonatal Ed. 2007 Mar; 92(2): F156.
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<a name="5"><b>5 </b></a>CDC. Group B Strep Infection in Adults. http://www.cdc.gov/groupbstrep/about/adults.html
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<a name="6"><b>6 </b></a>CDC. Group B Strep Infection in Newborns. http://www.cdc.gov/groupbstrep/about/newborns-pregnant.html
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<a name="7"><b>7 </b></a>Pinner RW, Rebmann CA, Schuchat A, Hughes JM. Disease Surveillance and the Academic, Clinical, and Public Health Communities. Emerg Infect Dis. 2003 Jul; 9(7): 781–787.
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</span>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com1tag:blogger.com,1999:blog-801873645877244873.post-87137015128196830332015-01-28T09:34:00.001-05:002016-01-28T12:39:58.623-05:00The Dark Side Of YouTube<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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It’s no secret that copyrighted content gets illegally uploaded to YouTube daily. Many of these videos are completely harmless (fan-made music videos, bedroom sing-alongs, etc). However, few realize that copyrighted content is also being illegally monetized on YouTube daily. This occurs when someone naively (or not so naively) monetizes their upload of a 3rd party work, but it also occurs in a far more troubling way: the systematic monetization of every upload of a 3rd party work via YouTube’s Content ID System. </div>
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If you’re unfamiliar with this system, basically a content owner can have their material scanned and digitally fingerprinted, and then that fingerprint is compared against all of the content available on YouTube. When a match is found, the content owner can choose what to do about it - monetize it, block it, or do nothing. While the system is a boon to content owners, it’s not without pitfalls; content can be mismatched (e.g. your personal home video of a thunderstorm gets matched to a song by some band you’ve never heard of), and in the reverse, content can be accurately matched but to the benefit of illegitimate parties with no actual legal claim to the material (e.g. your original work is said to be owned by someone else). Although YouTube provides users with the option to dispute a claim, the dispute process is narrow in scope - if a video you uploaded has been falsely or wrongly claimed by another party, you can only dispute the claim as it pertains to your specific upload of the material…you cannot dispute the claim or claimant on a system wide level throughout YouTube.</div>
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Last year, I happened to click into a video uploaded to my personal YouTube channel - this is a video containing my original song as audio, with the associated album artwork as the visual component - lo and behold, an advertisement pre-roll began to play. Hmmm that’s odd, since I don’t have monetization enabled on any of my videos. Let me go and check to see if I have any copyright notifications in my account. Oh look at that, I do. I wonder how long that’s been there (the video in question had 700k views)…and I wonder why YouTube never sent an email to inform me that a copyright claim has been placed on my video (seriously YouTube, you send me an email every time a person daydreams about one of my videos, you can’t send an email when a copyright claim is made?).</div>
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The copyright notification stated that a section of my song had been matched to someone else’s recording, and it listed the title of that recording and the company that administered it. I searched the title on YouTube and discovered that this person had sampled my song within their recording. So in addition to sampling my song without permission, they evidently also submitted their recording to YouTube’s Content ID System, which then flagged my content - the content they illegally sampled - as matching their content! You’ve got to be kidding me.</div>
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Time for me to dispute this claim. Click “dispute”. Reason: I own 100% of the copyright to the sound recording and composition. </div>
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Ok, got that taken care of. Hey, wait a second. If YouTube’s Content ID system flagged my upload as matching their content, then it would flag other 3rd party videos containing my song as well (e.g. “fan videos”). Although YouTube does instruct a copyright claimant to review the video and reference material when a match is disputed, there is nothing obligating a bogus claimant to remove their content from the Content ID System. In other words, if someone utilizes the Content ID System to falsely claim copyright to my song (whether the result of honest oversight, or because they’re assholes), even when I dispute the claim, I’m only disputing the specific match against my specific upload - there is no way to dispute the legitimacy of the Content ID Asset (the reference file) being used to match the content in the first place. So despite my successful dispute, all other 3rd party uploads of my material will continue to be monetized by this bogus claimant, unless those 3rd party uploaders also dispute the match (which they won’t, since they never got permission to use the material to begin with, and will probably assume the source of the claim is the legitimate owner anyway). </div>
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And best of all, whatever money the bogus claimant and YouTube have earned from the illegal monetization of my copyrighted material remains in their pockets, even after a claim is successfully disputed. That’s right - apparently you can use the Content ID System to hijack content you do not own, monetize that content indefinitely until your claim is disputed (if it ever is), and then keep the money that you unlawfully earned up until the dispute occurred (along with whatever money you continue to earn from undisputed claims)!!!</div>
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Oh, and by the way, it’s not just recordings that can get hijacked - it can be the composition as well. I encountered this a few months after the above incident, when the Content ID System flagged another original song of mine as matching someone else’s song. Again, I was being told that my song wasn’t my song, but rather this other party’s song, which was stated to be administered by “one or more publishing rights societies” (thanks for that detailed information YouTube). Here too, I didn’t even find out about it until I happened to click into the video and saw the ads appear (so who knows how long it was being monetized for - the video had 385k views). And here too, I disputed the claim successfully, but other 3rd party videos of my song were still being monetized by this party (as confirmed to me by more than one uploader of such videos) - and FYI, one of these 3rd party videos had over a million views.</div>
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I sent an email to copyright@youtube.com about this matter, which stated in part: “I had assumed that after disputing the claim, all relevant matches would become terminated...but this is not the case. So how do I prevent this party from continuing to unlawfully claim and monetize my content on YouTube? Can you provide me with the name and contact information of the party responsible for this claim, so that I may follow up directly with them?”</div>
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I never received a response.</div>
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Wonderful. So what can I do about this? I suppose I could search for all 3rd party uploads of the song in question, and then issue DMCA takedown notices (compulsory notices obligating YouTube to remove content from their service) for all of the videos that are being monetized (I have no objection to nonprofit and non-commercial use of my material on YouTube, so I would leave that alone). Except then I would be jeopardizing the YouTube accounts of fans who were simply celebrating and sharing my music, or who intended to harmlessly express themselves without any monetary component involved; fans who typically have little to no understanding of copyright in general, let alone that some asshole has hijacked their video and forced me to shut it down. So everyone loses in this scenario - the fan’s YouTube channel gets penalized (or terminated), I upset (or lose) the fan, and…oh right, the bogus claimant and YouTube don’t lose anything, apart from additional ad income they were never entitled to in the first place. And regardless, with this strategy there is no way to search for the anonymous use of my material within 3rd party uploads (i.e. where the artist / song title are not listed in the title or video description text, rendering such use undiscoverable through YouTube’s search engine). Not to mention, I would have to endlessly monitor YouTube moving forward for new 3rd party uploads of the material in question (since YouTube scans new uploads against its Content ID database).</div>
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Hmmm. I guess an alternative course of action would be to send a message to each uploader alerting them of the unauthorized monetization, with instructions that they must disable the ads, or otherwise confirm that their video has been claimed by a 3rd party and if so, have them proceed with the dispute process. I’m tired just thinking about it. Of course, there’s no guarantee any response would be forthcoming from such uploaders. And honestly, I don’t have the time to effectively police YouTube in general, let alone launch a campaign of this sort. And once again, YouTube would need to be continuously monitored moving forward, in case new 3rd party uploads of the material in question popped up in the future.</div>
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Damnit. If only there were some technology that could automatically locate every video on YouTube that used my content, on an ongoing basis, which would also allow me to prevent assholes from illegally monetizing my work. Oh wait, there is such a thing - it’s called Content ID!!! Hold the presses!!! I’ll simply sign up for a Content ID account myself, and then YouTube won’t be able to enforce other people’s illegitimate claims, since my own claims would either undermine or take precedence over them. Although multiple parties can lay claim to a video, when the total claims exceed 100% of the copyright in a song (which they would when dealing with bogus claimants), YouTube has no way of determining which party has rightful claim to the content and leaves it to the vying claimants to sort out - in such a scenario, no advertising payments can be made until the conflict is resolved, so at the very least this would prevent a bogus claimant from continuing to profit off of my work. </div>
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Similarly, when new reference material submitted to Content ID matches other reference material previously submitted to the system, YouTube again has no way of determining which reference should have priority, and leaves it to the vying claimants to sort out; in the event the parties can’t agree, it defaults to siding with whoever submitted the reference material first. This protocol assumes the first party is most likely the legitimate claimant, but of course, a bogus claimant may beat you to the punch (as in my case)…so if a bogus claimant decides to be an exceptional asshole, they could stubbornly cling to their illegitimate claims, and force legal action on my part, but at least at that point I would have access to full contact details of the bogus claimant, and could then properly resolve the matter; and at least with this strategy I would be able to have my entire discography scanned, and in so doing, defensively position myself against future attempted hijackings.</div>
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Content ID System, here I come! Well, not so fast. A Content ID account isn’t something anyone can get - you have to apply for it, and then YouTube has to approve it based on their analysis of your need for the service. About two years ago, I did apply for a Content ID account, and six days later I was denied. Apparently, despite having aggregate views in the millions from 3rd party uploads of my music, and despite having issued numerous DMCA takedown notices in the past, I hadn’t demonstrated a need for their service. Perhaps my rejection had something to do with the fact that I did not check the “I want to monetize 3rd party uploads of my content” box, instead citing my desire to monitor and control unauthorized use of my material. Note to self: remember to check that box in the future when reapplying. Eight months later, in March of 2014, I attempted to reapply - but rather than being taken to the application page upon clicking the “apply here” hyperlink, I received the following automatic confirmation: </div>
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“Your information was submitted on Jul 19, 2013. Thank you for your interest in the Content Identification Program. Please be patient with us as we get to your request.” Great, so there’s no way to fill out a new application, even though I have new information that is relevant to YouTube’s reevaluation (assuming they actually will do a reevaluation). </div>
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Back to square one. I sent another email to copyright@youtube.com and debratucker@google.com (listed as YouTube’s DMCA agent) outlining the fraudulent copyright claims I’ve been encountering, my need for access to the Content ID System, and my inability to reapply for an account or update my previous application. No response was forthcoming. </div>
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Alright. There is another possible solution to this mess - there are various intermediary companies that have Content ID accounts, and which offer indirect access to copyright owners in exchange for a commission on the ad revenue earned from the monetization of your content. While this is certainly a viable solution, the problem for me is that I’m not interested in monetizing my music - I’m interested in stopping other people from monetizing my music (an endeavor that yields zero profits to such companies). </div>
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To be clear, there is nothing wrong with legitimate monetization of one’s content on YouTube. However, the issues I have with YouTube’s monetization program are 1) YouTube was built on the idea of sharing art for the sake of art, and it is in this spirit that I participate in the service, 2) Not everything in this world needs ads associated with it, and I do not feel compelled to exploit every possible opportunity to monetize my music - in the case of YouTube, I prefer that my songs are experienced without involving a tampon commercial or a sales pitch for the best stool cleaner on the market, 3) The deal terms with respect to advertisers, YouTube, and copyright owners are far from transparent, and the prospect of entering into a nebulous arrangement in which I’m not privy to all of the information isn’t something that appeals to me. In light of this perspective, intermediary services are of no help to me, as I will not be forced to participate in YouTube’s monetization program as a means of combatting their illegal monetization. Fuck that.</div>
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Ok, time to take things up a notch. With the assistance of an entertainment attorney, contact was made with a Google representative who said they could facilitate my access to the Content ID System. A few days later, I was emailed an NDA (non-disclosure agreement) as a precursor to moving forward. Shortly after electronically signing it, I was sent a Google publishing agreement. Huh? But I don’t want to enter into a publishing deal with Google, I just want to use their Content ID tool. Turns out, the only way I would be given access to YouTube’s Content ID System was by agreeing to the terms and conditions of Google’s publishing agreement. The problem was, the terms of their publishing agreement are terrible - they’re highly problematic in a variety of areas, and there was no way I could sign something that reprehensible. Which means, there was no way I was going to be granted access to Content ID.</div>
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In the meantime, more cases of illegitimate Content ID claims concerning my music sprouted up. In one case, completely unrelated material had been matched to my song. In another, an unauthorized sample of my song was utilized in a derivative work. In both cases, Content ID was claiming and monetizing my personal uploads of the recording, along with 3rd party uploads that contained my recording. Once again, I never received an email from YouTube notifying me about the copyright claims (I discovered them after a deliberate routine check of my YouTube account). And once again, I was only able to dispute the copyright claim as it pertained to my specific uploads…all 3rd party uploads continued to be unlawfully monetized.</div>
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Despite the lack of contact information provided by YouTube in connection with these bogus copyright claims, an internet search using the title of the work to which my content was matched successfully identified the parties responsible, to whom my lawyer subsequently sent notices with instructions to cease all monetization, release all copyright claims, and remove the fraudulent Content ID Asset from the Content ID System. In addition, they were instructed to account for all monies earned in connection with the illegal monetization of my copyrighted works (still waiting on that information). Needless to say, this strategy hasn’t worked out too well thus far…compliance is partial and intermittent, and new Content ID matches in connection with 3rd party uploads often seem to reemerge after the Assets in question are supposedly removed from the Content ID System. And it’s costing me money to implement this solution to boot. It sucks being principled.</div>
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I sent another letter to YouTube’s copyright department and Debra Tucker, informing them of an invalid Asset ID that was (and still is) wrongfully claiming my copyrighted content. This letter went on to state: “please advise as to the optimal procedure for notifying YouTube of invalid Content ID assets / claims moving forward. This is not the first time I have encountered an invalid Content ID claim in connection with my original music, and it is vital that I be able to promptly address inaccuracies and misrepresentations as they arise. I have previously applied for a Content ID account, however my application was denied for reasons unknown - without having access to the Content ID System, how do I a) acquire the contact information of a claimant, b) determine the associated Asset ID # of a claim, and c) properly notify YouTube of a claim’s invalidity?”</div>
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Drumroll please……….no response. </div>
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Now, can I sue the bastards that are illegally claiming and monetizing my music? I suppose. Will the end result outweigh the time, money, and stress involved in pursuing that effort? I’m not so sure. But if possible, I’d like to avoid starting a full time legal division devoted to YouTube copyright disputes (I’ve already got my hands full with copyright infringement issues outside of YouTube). Plus, good luck pursuing a lawsuit in the event a bogus claimant is overseas. And of course, YouTube is said to have no liability in the transgression under current copyright law, since they have no control over the actions of their users.</div>
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So when it’s all said and done, I’m left with no good options. To be clear, I think YouTube is a terrific platform, and I think the Content ID system is a fantastic tool for copyright owners. But it’s being exploited in troubling ways, and YouTube does not seem to be interested in finding a proper solution to the problem…why would they, when they are making money off of the problem?</div>
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It seems utterly obvious that YouTube should provide a mechanism by which to dispute the legitimacy of any Asset that Content ID is utilizing to identify matches. Additionally, YouTube should be required to disclose how much advertising revenue has been earned in connection with a successfully disputed copyright claim, along with complete contact information for the corresponding claimant. And while we’re at it, all advertising revenue earned by bogus claimants and YouTube could be paid out to the rightful copyright owners as a partial means of compensation for the unauthorized and illegal monetization of their works. Yeah, it’s quite the fantasy - but I can dream, can’t I?</div>
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Although YouTube may not be responsible for the illegal actions of its users, they seem to have conveniently set up a system in which it is virtually impossible to address the issues I’ve outlined (absent “joining the machine”). But let me address the following thought that is surely populating some reader’s brain at the moment - “if you have such a problem with YouTube, then stop using their service”. If only it were that simple. My abandonment of YouTube would have absolutely zero effect on the myriad 3rd party unauthorized uploads of my music that are being illegally monetized, and cutting my ties with YouTube affords me no greater leverage in addressing such infringement. There is no escape, my friend.</div>
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It’s interesting to consider that the reason piracy sites and streaming sites like YouTube have no liability when copyrighted works are illegally distributed throughout their networks is because of what’s referred to as the “safe harbor” clause under copyright law. There are a variety of conditions that must be satisfied in order for an OSP (online service provider) to be protected under safe harbor, one of which includes not receiving a direct financial benefit as a result of the infringing activity. It appears quite obvious that YouTube is very much receiving a direct financial benefit via their participation in, and receipt of, advertising revenue earned in connection with the monetization of illegally distributed videos on their service. </div>
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Another condition of the safe harbor clause is that an OSP offer “standard technical measures” to copyright owners, which refers to methods used to identify and protect copyrighted works. I would argue that YouTube’s Content ID System is precisely that, a standard technical measure, as indicated by its proven effectiveness at being able to locate and identify infringing content, along with the fact that its implementation is now a staple of the service and is in widespread use on a daily basis. And while YouTube’s online DMCA portal does facilitate (some) protection, it does not facilitate identification whatsoever.</div>
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So the question is - given the fact that YouTube has developed a mechanism by which infringing material can be identified, given that they deny legitimate copyright owners access to this mechanism, given that they provide no alternative mechanism by which a copyright owner can effectively combat Content ID abuse (nor a means by which a copyright owner can effectively notify YouTube of said abuse), and given the fact that YouTube is directly profiting from the monetization of infringing material - does YouTube meet the necessary conditions for safe harbor protection? </div>
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One thing is certain - without a sufficient mechanism to combat Content ID abuse that is accessible to all copyright owners, and without any punitive repercussions to illegitimate claimants and YouTube for the illegal monetization of copyrighted works, these abuses can only be expected to continue.</div>
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<i>UPDATE 1/28/16: I have written a follow up to this article, available <a href="http://zackhemsey.blogspot.com/2016/01/shining-some-light-on-dark-side-of-youtube.html" target="_blank">here</a>.</i></div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com16tag:blogger.com,1999:blog-801873645877244873.post-4998102154280491752014-10-10T12:46:00.000-04:002016-01-28T12:41:36.100-05:00Rome Wasn't Built In A Day, And Neither Was My Studio<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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Back in 2011, I built myself a humble studio, and after having painstakingly labored to get the acoustics to my satisfaction (<a href="http://zackhemsey.blogspot.com/2013/01/more-room-treatment-anyone.html" target="_blank">see here</a><span id="goog_1762669112"></span><span id="goog_1762669113"></span><a href="https://www.blogger.com/"></a>), I recently did something crazy: I changed everything.</div>
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This was not a case of me having a sickness. Nor do I particularly enjoy torturing myself, as “tuning” a room can be very tedious and frustrating work. No, this was about the never-ending quest for superior acoustics. You see, I wanted to get new speakers and a 2nd subwoofer, but the problem was that I would not be able to integrate them into the existing setup. So I had a choice to make: either maintain the status quo, or uproot my existing setup. Well, to hell with the status quo!</div>
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Let’s proceed like a movie that shows you the ending first, and then jumps back to the beginning. This is the new studio:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSVP7-6Ed30enkM3calZ9qcqHjUe_ZDDsHEXC8uE-fERINldSlSC8P41m8GIAwQru2JOs1cB4Vfm3J2VFut4_fXZAD2ZRPupr5gX5tC9k9ze-Ym2QwVolK1RYH1q7ETeLn-mOWfUIiwKZE/s1600/New+Studio+-+1+(front).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSVP7-6Ed30enkM3calZ9qcqHjUe_ZDDsHEXC8uE-fERINldSlSC8P41m8GIAwQru2JOs1cB4Vfm3J2VFut4_fXZAD2ZRPupr5gX5tC9k9ze-Ym2QwVolK1RYH1q7ETeLn-mOWfUIiwKZE/s1600/New+Studio+-+1+(front).JPG" width="320" /></a></div>
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This is the old studio:<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwXuLl7-2o5m1TOqaOgrWgiwQnJKR3y67ygfeePAD2jHps-vvPnLB53uRRXD4UrOCjsFKFRTu3G4mMPGvhrJ5dXNTL2R21W_mjIF4tjz5KeLGTjVk7zc0tWwUzqYnS2tcRBxnW3VE_oD6U/s1600/New+Studio+-+3+(old%2Broom).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwXuLl7-2o5m1TOqaOgrWgiwQnJKR3y67ygfeePAD2jHps-vvPnLB53uRRXD4UrOCjsFKFRTu3G4mMPGvhrJ5dXNTL2R21W_mjIF4tjz5KeLGTjVk7zc0tWwUzqYnS2tcRBxnW3VE_oD6U/s1600/New+Studio+-+3+(old%2Broom).jpg" width="320" /></a></div>
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In comparing the before and after you will notice, A) the orientation within the room has changed, B) a window has magically appeared, and C) there’s less acoustic treatment in the room (about half as much). The change in orientation was mainly a practical one - with larger speakers, and more of them, changing the orientation better accommodated all the pieces of the puzzle. As for the window, it was always there but previously it was boarded up with a custom-made panel in order to create a continuous and uniform wall surface (and it was completely obscured by acoustic treatment). In the old setup the room measured better with the panel in the window, but in the new orientation it measured better without it. Wonderful...now I get to be exposed to actual daylight during the day! </div>
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For those unfamiliar with this topic, when I refer to measuring a room, I’m talking about measuring the frequency response of the room - i.e., how sound propagates throughout the space and collects at the listening position. This is achieved by setting up a microphone to record the dispersement of sound emitted from the speakers - then that recording gets analyzed by acoustic software and presented as a set of data, which can be used to make comparisons.<br />
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You might be wondering, how could I possibly achieve equal acoustic results using half the amount of acoustic treatment? The truth is, I don’t have equal results…I have better results. This miraculous feat was achieved through a combination of factors.</div>
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To start with, much of the acoustic battle can be waged with strategic placement of the speakers and listener. As you change the position of the speakers, you change the way the room is excited and the way in which sound reflects off the walls, which affects the resulting sonics at the listening position. And as you change the listening position, the amalgamation of those reflections that reach the listener are altered.</div>
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In the old room, the speakers were on console shelves. This meant that the main speakers and the listener could only be moved together as a single unit, thus limiting the potential acoustic progress you can make using positioning alone. With the new speakers on dedicated stands, now the speakers and listener could be independently moved, allowing more progress to be made. In addition, adding a 2nd subwoofer into the equation provides further flexibility, as there are more placement possibilities with two subs compared to one (as well as other acoustic benefits), thus allowing even more progress to be made.</div>
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So the first thing that needed to be done was to remove all of the existing room treatment, which resulted in a room that looked like this:<br />
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And a garage that looked like this:<br />
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Swap out the old speakers for the new speakers, bring in the additional sub, and let the games begin. In the end, with more possibilities for speaker / listener placement in the new studio, more acoustic issues were able to be addressed with calculated positioning, which meant there was less heavy lifting that needed to be done using acoustic treatment. But make no mistake, there was still lifting to be done. Enter Modex Plates.</div>
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Modex plates are pressure-based traps that get flush mounted to a wall surface. I had never used such treatment before, but based on its reported effectiveness, I decided to take a chance and buy a few. These plates are gargantuan in size (roughly 3’ by 5’) and quite cumbersome to maneuver singlehandedly - two of the plates I purchased weighed 65 pounds each, and the other two plates I purchased weighed 80 pounds each (FYI, I did actually weigh them). This posed a significant challenge when it came to measuring their acoustic effect in the room, since I didn’t want to permanently mount them until I knew where they would yield the best results. However, if not mounted or physically held against a wall by a human being, they would topple onto the floor. But having people hold the Modex in place during a measurement would skew the frequency response, making it difficult to isolate the effect of the treatment from the effect of the bodies in the room. I needed the room to be vacant, but I also didn’t want to have to put a ton of holes into my walls while experimenting with where these plates should go. So I put my thinking cap on. And then I got out the chop saw.</div>
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The plan was to lay a couple of boards on the floor in order to raise the plate above the floor trim, thus allowing it to be pressed evenly flush against the wall. Then to prevent the plate from tipping over, I’d use non-slip pads and pieces of 2 x 4 with the ends cut at a 45 degree angle to hold the Modex in place, and they would in turn be held in place by dumbbells. The plates were said to be most effective where boundary surfaces intersect (e.g. room corners), so I focused my efforts in the rear corners, as features of the room made that the only viable option for symmetrical positioning of these behemoths.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEILj8U7Kfsa9TP7rDZWegXHgheyL5dgxCQGyFlVyiJSzzmsRZpPJQRr9xM0n4nlGVA40R4OccSFPcNRlYH20cnKCEhqG7BeKmVPA2qC2lIHNs_0Y8lOPP_6XjnQnLE9sawK3nUfsFV7EB/s1600/New+Studio+-+6+(modex%2B1).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEILj8U7Kfsa9TP7rDZWegXHgheyL5dgxCQGyFlVyiJSzzmsRZpPJQRr9xM0n4nlGVA40R4OccSFPcNRlYH20cnKCEhqG7BeKmVPA2qC2lIHNs_0Y8lOPP_6XjnQnLE9sawK3nUfsFV7EB/s1600/New+Studio+-+6+(modex%2B1).JPG" width="320" /></a></div>
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Success! I tested each plate type accordingly. Then I realized I also needed to measure all 4 plates together, in order to assess their collective influence.<br />
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Great. But I also needed to measure how the plates would perform when placed closer to the ceiling.<br />
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And of course, all 4 plates near the ceiling at one time.<br />
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Brilliant! I was now ready to commit to placements for 2 of the plates. As for the others, the jury was still out. What if I tried putting them on the actual ceiling? How could I accomplish that without actually permanently mounting them? Hmmmm. I’ll place speaker stands on top of plant stands that have an adjustable height via a rotating top. The speaker stands have a wider base than the plant stands, so I’ll use a sheet of plywood as a medium between the two. Then with the help of an assistant, we’ll rotate the top of the plant stand until the Modex is firmly wedged into the ceiling.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3Dnsw-zFwHNyUMFTvs3w39AMezVGpfmv0oR9e-0_aUv2vt2_74VJ77lTptaCXb1hyphenhyphenHL-kXRHV_qJ2yO9vEd_xinPOM-cHq5l5esIW4Jxl4MUY48foCgNB9TmHBHXRtcBfNftyh0R2x_Rk/s1600/New+Studio+-+12+(modex%2B7).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3Dnsw-zFwHNyUMFTvs3w39AMezVGpfmv0oR9e-0_aUv2vt2_74VJ77lTptaCXb1hyphenhyphenHL-kXRHV_qJ2yO9vEd_xinPOM-cHq5l5esIW4Jxl4MUY48foCgNB9TmHBHXRtcBfNftyh0R2x_Rk/s1600/New+Studio+-+12+(modex%2B7).JPG" width="320" /></a></div>
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Boom baby! I admit that was rather unsafe. Definitely do not try this at home - one error in judgement, and 80lbs will fall right on top of you - it will not be pretty. But if you’re as psychotic as me, you’ll realize that the only way to get the answers you need is to proceed accordingly (and cautiously). Ultimately, a comparison of all the various measurements showed the best results came from this arrangement:<br />
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The Modex Plates are sitting on custom-made wood platforms, and the top of the plates are held flush against the wall by 1" L brackets that I installed into the ceiling joists. This was an easier method of mounting than that suggested by the manufacturer, and it allowed me to position the plates right up against the ceiling / wall boundary (which would not have been possible using the mounting brackets that came with the plates). The other side of the room has a baseboard radiator, so at my wife’s suggestion we installed a permanent shelf into that wall.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiesj_Jhyphenhyphen2jNRLaFTPu8AnTrXlnKSqUPzxBPs-AiJg6SGpv0L9e3VswdTowQRlHRP09NtASzcfipRk43ZZRymQLrADIpd9Ea4MH6c_lWi_4J_KDnRAmF0lrc9YCqIu-bkRtplBzYRSfsvyI/s1600/New+Studio+-+14+(modex%2B9).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiesj_Jhyphenhyphen2jNRLaFTPu8AnTrXlnKSqUPzxBPs-AiJg6SGpv0L9e3VswdTowQRlHRP09NtASzcfipRk43ZZRymQLrADIpd9Ea4MH6c_lWi_4J_KDnRAmF0lrc9YCqIu-bkRtplBzYRSfsvyI/s1600/New+Studio+-+14+(modex%2B9).JPG" width="320" /></a></div>
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That’s pretty sexy. Now on to testing my other acoustic treatment. This absorption and diffusion functions by engaging sound as it is in motion, a design that requires an air gap between the treatment and the surface behind it. As you change the size of the air gap, you change how the treatment performs. Similarly, as you change the thickness of a panel, you change its effective range. So I did an extensive trial of testing, using 6’ columns, 4’ columns, and 2’ columns at every given location, with air gaps between 0” and 5”. I also tested panel thicknesses between 2" and 6", and compared different types of absorption and diffusion. And I tested the treatment free-standing directly on the floor, and at various distances off the floor using wood platforms. If you can think of it, I probably tried it.<br />
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With myriad measurements in hand, I eventually settled on the following configuration for the rear side walls:<br />
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When it came to the front corners of the room where the subs are located, I concocted a framework of platforms that allowed me to stand treatment on top of the subwoofers.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghDd6iwPk1bnHBCGDPNkQBPqObrq1zmIDZfgvE3MQdSeIodD66bPC0TZsZkKa8DCO1wSL9ehpdRbejD1KAGWCAdl1jifLVqZzhCZYqkKAIUlM8att5Si_4Q9dy9hberq4xAXJmknRxMQlx/s1600/New+Studio+-+15+(sub%2Bstand).JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghDd6iwPk1bnHBCGDPNkQBPqObrq1zmIDZfgvE3MQdSeIodD66bPC0TZsZkKa8DCO1wSL9ehpdRbejD1KAGWCAdl1jifLVqZzhCZYqkKAIUlM8att5Si_4Q9dy9hberq4xAXJmknRxMQlx/s1600/New+Studio+-+15+(sub%2Bstand).JPG" width="320" /></a></div>
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Then I tested various configurations before making a final decision. Here are some examples that didn't make the cut:<br />
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Ultimately, a diffusion panel 2” from the front wall and 4” from the side wall yielded the best results (as to why those specific distances were best, or why diffusion instead of absorption, I have no idea…all I know is it measured best this way).<br />
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In the old room, I had many layers of this treatment (made by Real Traps), which collectively consumed a great deal of the available free space. In the new room, the independent positioning of the speakers / subs / listener along with the utilization of the Modex Plates (which are less invasive due to their flush mounting), resulted in needing to use a little less than half of the prior acoustic treatment. Which means, I have more space in the room now. Which means, it’s time to dance.</div>
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For those wondering, the black and white panels depicted in these images do different things. The black panels absorb low to high frequencies, and the white panels absorb low frequencies only. I had them colored this way when I bought them so that I would be able to easily distinguish each type. Any perceived color coding of the room is completely accidental - things just happened to work out in the way that they did.</div>
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As for the ceiling, the two panels above the speakers (and those to the left and right on the side wall / window) are absorbing the 1st reflection points between the main speakers and listener. Another 2 panels on the rear ceiling took care of a ringing that would have interfered with recording a vocal or instrument in the room. Then I placed some small diffusor squares around, which had a subtle but positive effect on the room's high frequency response. FYI, the blue lines in the following image are chalk markings - left to right indicates the location of ceiling joists, and front to back frames the center of the ceiling.</div>
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The last step was to dial in some corrective parametric EQ for the icing on the cake. For the audio novices among us, EQ is short for equalization, which is a process that is used to modify the sonic characteristics of an audio recording. With respect to room acoustics, the sonic characteristics of a speaker can be adjusted using EQ, so as to offset certain features of the room - for example, if the room is creating excessive energy at 70Hz, EQ can be applied to reduce the amount of 70Hz before the sound comes out of the speaker in order to compensate for the room’s effect, thereby creating a balanced sound at the listening position. One of the beautiful things about Genelec’s digital line of speakers (in this case, a pair of 8260s and a pair of 7270s) is that each speaker individually contains a comprehensive set of EQ filters that can be independently adjusted and fine tuned with precision. Such corrective EQ can be quite beneficial, particularly when dealing with smaller rooms where it can be impractical or impossible to address certain anomalies any other way. Indeed, if acoustic treatment is a butcher’s knife, EQ is a scalpel. </div>
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You might be wondering though, if we can just EQ the speakers to compensate for the room, then why was this entire acoustic treatment fiasco even necessary? The answer is that EQ by itself is insufficient for the task: A) it cannot compensate for nulls in the frequency response, which is where sound reflections cancel each other out, therein creating a void or “hole” in the audio, and B) in an untreated room, the frequency response can vary greatly as you move within the room, thus rendering any EQ adjustments only relevant to a narrow listening position. So you need to address as much as possible using acoustic treatment first, before moving on to consider corrective EQ measures.</div>
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With everything said and done, and around 250 measurements later, the new room sounds phenomenal. A couple of tissues taped to the ceiling to diffuse the light, and this studio is officially a wrap. Yes, it was all worth the effort. And now that the studio is finally finished, I can begin making some music again. Well, at least until the next studio escapade!!!!</div>
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<i>UPDATE 8/12/15: There has been one more important addition to the studio - see <a href="http://zackhemsey.blogspot.com/2015/08/i-swear-i-did-it-for-acoustic-reasons.html" target="_blank">here</a>.</i><br />
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com20tag:blogger.com,1999:blog-801873645877244873.post-71581850834004599342014-08-28T13:13:00.001-04:002014-11-14T23:20:43.231-05:00The Hospital Circus<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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My daughter Scarlet was just 4 days old when a routine pediatric visit detected an elevated heart rate over 200. There were no discernible symptoms, so we were all surprised. The pediatrician explained, "there is a range of normal and this exceeds that range, and if left untreated her heart will start to enlarge and you don’t want that”. Off to the children’s emergency room we go.</div>
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Upon entering the ER, an entourage of personnel appear, each asking various questions and each commenting “she looks a little jaundiced”…”yeah, she does”…”hmmm”. They confirm a heart rate of 230, and hook her up to an EKG to get a more detailed analysis. A cardiac specialist arrives and tells us that this sort of thing occasionally happens, for reasons unknown, but that it has nothing to do with the labor or pregnancy. After reviewing the EKG readout, he states that it’s most likely something called SVT, which is easily fixed using a medication called adenosine that gets administered through an IV. As they hook up the IV, he explains that this will work immediately but that Scarlet will need to continue receiving treatment over the course of a year, at which time we would reassess things. They administer the dose - heart rate drops to normal levels, everyone sighs, then it shoots right back up. Let’s try it again with a higher dose. Same result. Ok, let’s get another EKG printout. </div>
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The specialist goes to work analyzing the printouts and begins making some kind of calculation. He then concludes confidently that the proper diagnosis is actually something called atrial flutter - essentially, instead of blood flowing directly from the upper chambers to the lower chambers of the heart, it’s looping around the upper chambers first. This is good news, he explains, because it will not involve any ongoing medication. We simply correct the rhythm, and then we’re done forever. Sounds great to me. There are two treatment solutions: 1) chemical, via oral medication called propranolol 2) electrical, via shocking the heart. While he prefers the 2nd method due to it’s greater efficacy, he suggests we start with option # 1 because at this time of day (roughly 8 PM) we will need to stay overnight in the PICU for constant monitoring no matter what, so we might as well try the less invasive method first. The PICU sounds like a nice relaxing place to not get any sleep…can’t wait.</div>
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The plan is simple: give her one dose now, followed by a second dose 6 hours later, and a third 6 hours after that. If by noon tomorrow the tachycardia has not corrected, we will then proceed with shocking the heart. How long will the propranolol take to work? No way to know, he explains…”maybe it takes only one dose, maybe all 3, maybe it doesn’t work at all…the heart rate will be under constant supervision so we’ll just have to see how things develop…make sure you don't feed Scarlet after 8 AM, because if we need to shock her heart we want her to be on an empty stomach”. Roger that.</div>
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The first dose is given, and we wait in the ER room while our PICU suite is being prepared. 1 to 2 hours later, they set up a portable monitor and start transporting us. I notice the monitor shows a heart rate of 135, so I ask the nurse if that's an accurate reading of her heart rate. “Yes”, she replies. Wow, it looks like it already worked!!!</div>
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Into the PICU we go. A new cast of characters is now in the mix. Two nurses are getting things situated while discussing the plan with the chief of the floor. One nurse comments, “she looks a little jaundiced”. The other nurse responds, “yeah, she does”. I ask if the 2nd dose of medication will even be necessary, given her heart rate has already stabilized. The chief replies, “you’re going to need all 3 doses, otherwise the heart rate is just going to climb back up”. I guess he knows something the specialist doesn’t. The chief then says, “no feeding after 7 AM”, to which a nurse replies “oh, I was going to say 6 AM”. I inform them the specialist instructed 8 AM and the chief says “well, you can go up to 7:20”. Fine.</div>
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They do a general inspection of Scarlet, ask the same background questions the ER staff did, and put her on IV fluids. A nurse then comes in hourly to assess things, mentioning at one point, “my daughter was jaundiced too and had to be under a light for 3 days”. Thank you for sharing that. </div>
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Around 1 AM a new woman enters the room and explains she is the resident nurse tonight, and that if we have any questions or concerns to just ask her. Then she takes a look at Scarlet and comments, “she looks a little jaundiced…has anyone told you anything about her being jaundiced?” Only the fools within this hospital. I explain her bilirubin tests were fine 2 days ago, and that earlier that day she was examined by the pediatrician who said nothing of jaundice. “Hmmm, she’s looking jaundiced, and it can start creeping up around this time…we’re gonna need to do a bilirubin test”. If you say so. As I look around the room, I’m struck by the seeming absurdity of attempting a visual assessment of jaundice in a room with yellow walls and yellow lighting. But I’m no doctor, I suppose. The resident nurse then tells me, “no feeding after 8 AM”. Got it.</div>
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Fast forward to 3 AM. Scarlet’s heart is still holding between 115 and 130 on average. I let a nurse know that it’s time for Scarlet to receive a 2nd dose of the propranolol. “Yeah, the pharmacy doesn’t have it ready yet, I just called - they’re making one up now”. Got it, no worries, it’s just my newborn’s heart rate we’re talking about here…it can wait. 3:30. 4:00. 4:30, the 2nd dose is administered.</div>
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Fast forward to 7:30 AM. I find the resident nurse and ask if the 3rd does will be pushed back, since the 2nd dose was given 1.5 hours late. “The 2nd dose wasn’t given at 3 AM?” she asks. No. “Why not?” How the fuck should I know? I explain that pharmacy apparently didn’t have it ready, for whatever reason. She looks to the other nurse, “why wasn’t I told about this?” Silence. She takes about 1 second to ponder my revelation, and says, “we’ll still give her the 3rd does at 9 AM as planned”. Ok.</div>
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9 AM arrives - no one comes in with the 3rd dose. Her heart rate is still exactly where it had been since transporting to the PICU. Now there’s a big head honcho on the floor, who I’m told by a nurse is “the boss”, presumably of the entire hospital, and he’s walking with a bunch of student doctors and nurses from room to room discussing each case. At 10 AM they get to my room, and the cardiologist on call joins them (the cardiac specialist from last night is no longer on site). They begin discussing Scarlet’s situation right outside the room, in plain view and earshot. I’m not sure if I should act normal, stay extremely still, or throw feces at them. The resident nurse from earlier is in the pack, and she starts giving a play by play: “heart rate elevated, they initially tried adenosine, then switched to propranolol, she’s had glucose checked every 4 hours, and she looks jaundiced so I ordered bilirubin tests” _ (side note: it took 3 bilirubin tests for them to finally let go of their jaundice fixation).</div>
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Bossman then asks the same series of background questions. Is she peeing and pooping? Yes. Any history of heart problems? No. Etc, etc. I hear him say something about the specialist wanting to given another dose of adenosine, so I insert myself into the conversation, explaining the specialist had initially considered doing so, but ultimately decided against it upon confirming his analysis of atrial flutter. Bossman asks if anyone knows what the heart rate was during labor, and I inform them that it was between 140 and 160 for the duration of the labor. Bossman turns to me, “how was the baby delivered”? Vaginally. “Was it a normal delivery?” Yes, the baby came out of the vagina and not the anus. He turns back to the huddle, “well if she’s peeing and pooping and breast feeding, I’m not that concerned given how great these heart rate numbers are looking”. </div>
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As the huddle begins to disband, I ask the obvious: “so is Scarlet still going to get a 3rd dose?” The cardiologist responds “yes, we’re going to give her the 3rd does…she’s going to be on this medication for a while, about 9 months, so we’ll be giving you medicine to administer at home as well”. I calmly explain that my understanding from the specialist was that once the issue was resolved by this afternoon, there would be no further medication required. She looks at me like I have two heads, and asks if perhaps I misunderstood the specialist. No, definitely didn’t misunderstand anything. In fact, come to think of it, I’m the only person here who actually had a face to face conversation with the man. She says “well, I’m going to check in with him, so I’ll see what he says…hey, I’d love to be wrong about this”. She walks out with her associate, and eventually comes back in to report that we don’t need the 3rd dose after all, and there will be no further medication required - we just need to do a final EKG and Echocardiogram for definitive confirmation. Great! </div>
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2 hours later, someone comes in to do the EKG and Echo. I’m told the results are being sent to the cardiology floor for analysis. 1 hour later, the cardiologist appears to say everything looks great and we can go home - we just need to wait for a nurse to prepare discharge papers. Shortly after, the cardiologist’s colleague from earlier comes into the room to give us a script for the propranolol medication that Scarlet will be receiving at home. Uhhhh, what? I explain that the specialist informed the cardiologist that such was not necessary. The colleague says “oh, I spoke to the cardiologist earlier and she told me this would be necessary”. “Right, well it would seem that the cardiologist spoke to the specialist after speaking with you, but neglected to follow up with you”. She says, “oh, ok, well then I’ll just confirm that with her, but it sounds like we won’t be needing this after all”. Another 2 hours later we have discharge papers. Get me the fuck out of here. </div>
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The moral of the story is, while hospital staff are tremendously skilled and caring people, the environment in which they work is often frenzied and the communication therein can be highly dysfunctional. And while it may be tempting to assume that this all must have occurred in some dilapidated institution with substandard personnel, rest assured the facility in question was very well regarded. So never assume that anyone knows what is actually going on…this is not to say don’t trust your doctor, but rather, don’t assume that your doctor has been fully informed. It is imperative that you attentively listen to everything that is said in your presence, ask whatever questions you may have, be highly observant, and not be too grief stricken or exhausted to monitor what is happening, or too intimidated to politely inform of any contradictions in procedure. </div>
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In addition, it has never become clearer to me that if left to their own devices, hospital personnel would eventually start transporting patients to underground bunkers. They are accustomed to encountering horrific situations and are therefore extremely paranoid about everything…this is entirely understandable, but it’s important to concede that this approach inevitably brings risk of unnecessary testing and treatment. So patients and families need to provide a balance, when necessary, in order to make sure things don’t snowball out of control. In the end, if I had not been as watchful during the above 24 hour saga, Scarlet would have received medication that she didn’t actually require…potentially 9 months worth! So let this be a cautionary tale. And please, conduct a thorough inspection of your children, because they're looking a little jaundiced from here.</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com5tag:blogger.com,1999:blog-801873645877244873.post-36654990223397774972014-08-24T13:07:00.000-04:002020-07-02T09:23:46.277-04:00Birth Lessons<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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In the months prior to conceiving, my wife began “preparing her vessel” as she liked to put it. She was regimenting her diet, working out regularly, and seeing an acupuncturist. It was important to her that she have an unmedicated natural delivery, and after much careful thought, we agreed that birthing at home was the most appropriate setting. Home birth requires a high degree of preparation mentally and physically, and we were both fully committed to the cause, devouring as much reading material as possible, taking birth classes, watching birth videos and lectures, doing birth specific exercises, eating organic and being nutritionally mindful, etc. So by the time labor was upon us, we were ready.</div>
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The first initial contractions began late evening on August 14th. They were inconsistent and intermittent, so I figured real labor wouldn’t begin until the following afternoon. I was in the middle of re-formatting my studio, a process that had been underway for weeks, and I had been working the entire day - now knowing that labor was around the corner, I decided to put in some extra work that night to cover a little more ground before the birth put everything on hiatus. Close to midnight, labor started picking up and by 3 AM it was in full swing. With only 2 hours of sleep under my belt, I woke up and started timing the contractions over the next hour…they averaged 57 seconds long, every 4:30. It’s going down, folks.</div>
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Lesson #1: Whatever work related projects, fitness routine, family drama, or other activities that you’ve got going on, none of it deserves your attention once the initial labor contractions begin. If contractions could talk, their onset would translate to: “hey asshole, drop your bullshit, get focused, and get some rest…you’re gonna need it”.</div>
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At around 6AM the doula arrived. I feed the cats, make breakfast, and set up a birth pool that we had rented. We then proceed to work like seasoned masseuses, utilizing various massage techniques during and in between contractions, along with frequent words of encouragement, while Heather is vocalizing with every contraction and attaining full-body relaxation. At 11:45 AM, the midwives arrive and do an internal exam to establish where things are. My wife requests that they not tell her how dilated she is, and I agree - what’s the point in knowing - let’s just keep working. </div>
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1 PM brings a surprise power outage to the neighborhood, something that hasn’t happened since Superstorm Sandy in 2012 (at least on this particular day it was cool and sunny). As we’re all scratching our heads trying to figure out how to heat up water with no electricity, my wife blurts out in between contractions “hook up the new propane tank and boil water on the grill”. Ingenious!</div>
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By 3 PM the power was back online - yes! 4:10 PM, the midwives do another internal evaluation and simply report “you’re making progress”. The work continues…in the pool, on the bed, on the toilet, in the shower, lying down, sitting up…drinking, snacking, peeing regularly. </div>
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8:25 PM, another internal evaluation. “You’re at the same place you were last check”. Really? Whatever, back to work. Labor outside, labor inside, from this position to that position. Soon my wife starts reaching a point where she expresses doubt about whether or not she can really do this, an expected signpost during Stage 1 of labor - this is encouraging, and we in turn continue to encourage her. She eventually vomits (twice), and while ostensibly a terrible occurrence, in truth it is another good indication of progress. </div>
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10:15 PM, another evaluation…no change. The mood now shifts considerably, and the midwives raise the prospect of transporting to the hospital. I’m completely blindsided by this. Ok, what’s the story here, where are we at? “She was 4 cm at noon, and she’s been 7 cm since 4 PM, and the baby has not dropped at all”.</div>
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They breakdown the situation further, explaining the holdup is resulting from the position of the baby. Although head down, it’s not the traditional vertex position…it’s occiput posterior (OP). Normally at around 7 cm the baby’s head will have made contact with the cervix, and the resulting pressure, in conjunction with the contractions themselves, dilate the cervix the rest of the way. In our case, the OP presentation was preventing the baby’s head from being able to engage the cervix, thereby stalling progress, and the all-forward nature of how Heather was carrying (you couldn’t tell she was pregnant from behind) was not helping matters.</div>
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Lesson # 2: Some things are simply out of your control. In the case of birth, nothing can mandate the presentation of a baby - you can take steps during pregnancy to encourage optimal positioning (which we did), but you cannot guarantee what the presentation will be the day labor begins. All you can do is play the cards you’re dealt as best you can. Such is life.</div>
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The midwives decide to administer IV fluids in order to help boost her energy levels (she wasn’t able to eat by this point), and they communicate in no uncertain terms that we’re approaching a crossroads - it’s time to dig deep or transport. My wife rises to the occasion. We work for another 4 hours, utilizing specific positions and rebozo techniques to counteract the OP presentation, along with aroma therapy, acupressure points, nipple stimulation, and herbal remedies that had been exploited on and off throughout labor. A caravan develops as Heather walks throughout the house, with the doula in front of her, me behind her, and the midwife’s assistant holding up the IV fluids on a broom stick leading the parade - surely a peculiar sight to see out of context - when a contraction came, we all paused and Heather would lean back onto my lap as a midwife deftly placed a chair under my legs. </div>
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Her “shelf” was dropping (the high point of the baby in the abdomen) and amniotic fluid had released (suggestive of a break high in the amniotic sac, as opposed to a traditional rupture)…both very encouraging. Her vocalizations took on a new caliber of intensity, as her contractions got even longer and harder - she was deep in the labor zone, as were we all. She began reciting affirmations, along with everyone else. “I can do this” / “You can do this” / “Welcome it” / “I welcome it” / “You’re body won’t give you anything you can’t handle” / “My body and baby know how to birth” / “The pain will lead you to the baby” / “Follow the pain to the baby”. Whatever heights were reached before, we were now in uncharted terrain. My wife got to a place she didn’t think she could get to, and she continued charging ahead. The atmosphere was electric, and we all felt that we had turned the corner.</div>
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At 2 AM, the midwives do another evaluation….7 cm, no change. The devastation and disappointment was palpable. I can tell from everyone’s facial expressions that it’s game over, but I can’t accept it. I insist Heather can still do this, but my wife is protesting. They clear the room, and I tell Heather, “I don’t care that you’re still 7 cm - no woman dilates on a set schedule - you could be at 10 cm in the next 30 minutes for all we know - and we have been seeing other indications of progress - you are so close, you can do this”. “Zack, you don’t understand, I can’t do this anymore”. “Yes, you can”. </div>
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The midwives return and explain that Heather’s degree of exhaustion has gone too far, that her uterus has become too fatigued, and that in their medical opinion it is time to transport. I recognize that I’m the only one who thinks continuing is an option, and it angers me - I’m angry that they are giving up on her, I’m angry that I am failing my wife in not being able to convince everyone (including her) that she can still do this, and I’m angry that on some level I too know it’s time to transport. Of course, contractions are still coming, and as I’m anxiously trying to figure out some way to salvage this, my wife’s vocalizations take on yet another caliber of intensity, only this time the sound she’s making is of a very different nature, and it goes right through me. In that instant, it became clear to me that my wife was no longer laboring, she was being tortured. </div>
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“Ok, we’re going” I declare.</div>
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Lesson # 3: There’s what you want your birth to be, and there’s how it actually goes. Unfortunately these two things don’t always match. It’s imperative to never let one’s attachments and desires, however important and cherished they may be, get in the way of making objective assessments.</div>
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Now, there are 2 hospitals we can transport to. One is 20 minutes away, and the other 40 minutes, but the further hospital is the preferred choice of the midwives in a non-emergency. There is no fetal distress whatsoever, so it’s up to Heather. She opts for the preferred hospital 40 minutes away. The midwives call in advance, and begin packing their stuff. I’m secretly hoping that by the time we get Heather into the car or to the hospital, she will have completed transition and we’ll birth this baby in the car. Heather begins apologizing to me and everyone, for which we all admonish her, while I mask my grief that this is really happening…I don’t want her to know how upset I am, because as the midwives explain, there’s still a lot of work ahead - this baby still needs to be born, and the top priority now is having a vaginal birth at the hospital. Off we go.</div>
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Driving at 3 AM through winding country roads while your wife is laboring in the backseat is not something I recommend doing while sleep deprived and exhausted…but with adrenaline pumping, you’d be surprised at how efficiently you can accomplish this. Oh, hello deer - hitting you is the last thing I need right now. My wife was miraculously silent during the entire drive, apparently summoning the will from not wanting to cause me to panic, while I too was miraculously silent for not wanting to cause my wife any additional distress…if we’d been in separate vehicles, I would have been weeping.</div>
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It’s close to 4 AM as we arrive at the hospital. Quick pee outside in front of the ER entrance (my wife, not me) and we proceed inside. Heather continues to apologize to everyone, and a nurse tells her reassuringly “hey, you got to 7 cm all on your own, you should be proud of yourself”. All I’m thinking is “fuck you, lady”. The hospital midwife on call assesses dilation at 8 cm. The anesthesiologist eventually arrives around 5 AM to administer an epidural just as Heather vomits for a 3rd time, at which point they also start her on a conservative drip of Pitocin. Basically, although her uterus was still contracting regularly, it was now so fatigued that the contractions were believed to be too ineffective to dilate her cervix the rest of the way…so the plan was for the epidural to allow her to go to sleep in order for her body to rest, while the Pitocin beefed up the contractions in the meantime without her being aware of them. The birth team disperses, and Heather and I try to get some sleep.</div>
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Lesson # 4: The amount of routine unnecessary medication and intervention during labor is disturbing - from induction to epidurals to episiotomy to cesarian - such measures should always be a last resort, yet too often they are utilized out of convenience, ignorance, habit, or paranoia. However, when there is a true medicinal purpose, intervention can be a truly beautiful thing. Never stubbornly refuse an intervention for the sake of principle alone - if you genuinely need help, accept it.</div>
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A couple of hours later, the hospital midwife checks her dilation. No change. “We’re gonna up the Pitocin a little bit and give it another hour”. One hour later, no change. “We’re gonna up it a little more and give it more time”. Another hour later, no change. My wife is starting to panic, but I remind her that the baby isn’t in any distress, and it’s simply a question of giving her body the time it needs, to which the hospital midwife responds “well I don’t want to say we have all the time in the world - this is a really protracted labor, and if we don’t see progress relatively soon, we’re going to have to start having a very different conversation”. You’ve gotta be fucking kidding me. “But we’re gonna up the Pitocin a little bit more and see what happens”.</div>
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30 minutes later, our birth team walks back into the room like knights in shining armor. At the next check, Heather was 9.5 cm _ [cue angelic choir] _ and before we knew it she was feeling the urge to push (by which point the epidural had worn off). And push she did, with a fervor and intensity that belied she had been in active labor for over 30 hours. After another gauntlet of birthing postures to facilitate the baby’s positioning, finally at 11:24 AM on August 16th, Scarlet Sage Hemsey was born. The sense of triumph that pervaded all of our spirits in this moment was extraordinary…it felt like snatching victory from the jaws of defeat.</div>
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Lesson # 5: Throughout our stay at the hospital, I was thinking about all the time and energy that we had put into birthing at home, all of our efforts during the last 9 months of pregnancy (and prior), and the 30 hours of laboring we had just completed before transporting - this tremendous investment, and it was all for nothing. But the truth is that our investment had in fact paid off, just not in the way we had expected it to. The hospital was on the verge of doing a cesarian section when Heather finally dilated to 10 cm, so if Heather had not already been birthing at home for those 30 hours, or if she had decided to birth at the hospital from the outset, C-section would have been a certainty. In the end, home birth is what made vaginal birth possible.</div>
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Lesson # 6: The more learning and preparation you do in advance of labor, the more confident you will be when it’s underway. However, there is a potential pitfall for expecting parents who know all the intricacies of birth, what to expect, and have a clear vision of what lies ahead…and that is if / when labor strays from how it was imagined to be, it can be extremely scary and disconcerting, and very difficult to let go of prior expectations and accept what you’re presented with. You can do all the reading in the world, but none of it will allow you to truly anticipate what labor will feel like or how your particular labor will unfold. So know what to expect, but don’t have any expectations.</div>
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Lesson # 7: Hindsight is not always 20/20. If I could go back in time, there are a variety of things I would try in an effort to change the outcome…maybe if we had spent more time in these birthing positions instead of those, Heather would have progressed faster…maybe if Heather listened to music, she could have focused or relaxed more…maybe if I had made more fresh fruit juice (perhaps 6 glasses instead of the 2 that I did), she would have had more energy…maybe if I called her acupuncturist for a home visit during labor, she would have been able to do something to affect the baby’s position and/or Heather’s stamina…or maybe we could have driven over bumpy roads and bounced that stubborn baby downwards. But the reality is there’s no way to know if any such alterations would have affected the outcome (and if they did, whether for better or worse). In navigating labor, all you can do is make your best on-the-fly judgement each step along the way.</div>
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Lesson # 8: Initially looking back, I thought maybe I was wrong to have championed my wife onwards at 10PM when the prospect of transport was first raised. Perhaps she endured 4 more hours of pain unnecessarily. However, in truth, I think it would have been a disservice to her to have done otherwise. Even though our rallying ultimately did not affect the outcome with respect to transporting, I believe it was extremely valuable to my wife’s psyche to have been able to summon the willpower and determination that she did during those last hours at home, and I truly feel that her birth experience would have been diminished without it. While we should absolutely seek to protect the well being of our loved ones, we should never doubt their resolve. I believed in my wife then, and I still believe in her now.</div>
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I remember thinking to myself at one point during labor, “who would ever want to be a midwife or a doula? This is so exhausting”. But when it was all said and done, I understood. My deepest gratitude to Susan Schmidt, Cathy Gallagher, Nancy McDaid, and Julie Hartman. I am forever in your debt.</div>
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<i>UPDATE 7/16/17: Read about the birth of our second child <a href="https://zackhemsey.blogspot.com/2017/07/birth-wisdom.html" target="_blank">here</a>.</i></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyC7OEuVfacEzmuASbFA3C8Ojrg4NVd7BNiczUTibM0a1-Z0HxVIhznWZKLsV7p-crzR83uWYIVXowOb4gKLGYCn1SHclOhV0o4Ujn0mH-WOqwZeDQEntow0FnxrxxrZcPWlCuFO9bedWA/s1600/Scarlet+Sage+Hemsey.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyC7OEuVfacEzmuASbFA3C8Ojrg4NVd7BNiczUTibM0a1-Z0HxVIhznWZKLsV7p-crzR83uWYIVXowOb4gKLGYCn1SHclOhV0o4Ujn0mH-WOqwZeDQEntow0FnxrxxrZcPWlCuFO9bedWA/s1600/Scarlet+Sage+Hemsey.JPG" width="240" /></a></div>
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com16tag:blogger.com,1999:blog-801873645877244873.post-35077323632134783692014-05-20T14:05:00.001-04:002018-10-03T09:25:48.997-04:00In Defense Of Free Will<div style="font: 13.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
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Honest discussions of free will are bound to become unsettling, if one is brave enough to go the distance. After reading <i>Free Will</i> by Sam Harris, one is definitely left unsettled. We all have the feeling of free will - that we choose what we do or don't do. The beating of our hearts may be involuntary, but we definitely decide whether or not to drink that glass of water. The idea that this could be an illusion flies in the face of our intuition and subjective experience. Yet, Harris makes a very compelling case that our sense of free will is exactly that - an illusion. This is not to say that a choice wasn't made to pick up that glass of water…it's to say that it wasn't you who made it. The experience of that action tricks you into believing you were the cause, when in fact you weren’t. As to who or what is doing the choosing, the decision to drink that water presumably resulted from brain states, neuronal patterns, and/or prior chains of events, all of which you have absolutely no control over.</div>
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Most people (including me) find such a prospect depressing. We'd like to think that we can take pride in our accomplishments and bear the responsibility for our actions - that our decision to run into that burning building to save those puppies was not the result of neurons that just happened to fire, but rather that those neurons fired because of a meaningful choice that we made. We'd also like to think that the serial killers and rapists of the world are responsible for their actions too, and not victims of their brain states and neurophysiology. Of course, the way that each person is neurologically and biochemically wired is certainly relevant to our actions and behavior, but we’d like to think such wiring does not encompass the entirety of why we do what we do.
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Now it should be pointed out that whether or not you have free will is inconsequential from the standpoint of your personal experience - you feel like you have control over your thoughts and actions, regardless of whether you actually do or don't. So in one sense, free will's truth or falsity is completely irrelevant, practically speaking. However, for the inquisitive among us, we'd still like to know what's really going on under the hood.
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It should also be pointed out that a lack of free will would not mean your experiences aren't genuine - they absolutely are - it would just mean that you are a helpless puppet along for a ride in a car that you are not driving. Similarly, it would not mean that you don't possess genuine knowledge, weigh career options, waver between dinner choices, plan out vacations, ponder your existence, react to the behavior of others, learn, problem solve, etc - you would still be doing all of these things, just not in the sense that matters - it would mean your biological system is doing them, while the consciously self-aware you (the real you) is merely experiencing the process.
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So I've been attempting to make sense of this issue for quite a while now, because I abhor the idea that we are merely selves helplessly trapped in bodies, with no autonomy, and that life is nothing but a bunch of billiard balls set into motion on a cosmic pool table in which all of our future paths and interactions are entirely pre-determined or otherwise predictable from principles of physics and mathematics. But as much as I don’t want this to be the case, one can't (or shouldn't) ignore evidence just because it's inconvenient or displeasing, and the fact of the matter is that Harris makes a very compelling case that free will does not exist. The stakes are high, my friends.
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Fortunately, after long and careful consideration, I suspect there may still be hope after all. What follows is my defense of free will, for the good of the land - because who better to reconcile Harris's anti-free will arguments than someone with no significant philosophical accomplishments or PhDs to his name? Yes, it must be me. Besides, as an undergraduate I got a minor in philosophy, so step off, bitches. Now if my efforts should miserably fail, then I suppose it won't really be me failing, since as it would turn out I would not have actually chosen (in the meaningful sense) to write this in the first place…a realization that should hopefully remove any potential embarrassment in the event someone comes along and utterly destroys this defense.
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Additionally, just to be clear, although I'm arguing that free will does exist, I'm not suggesting that we are in control of 100% of ourselves - just that we exert meaningful agency to some degree. Free will doesn't require that we control every influence, impulse, and desire, but rather, that we have the ability to resist, adhere, and add to that tapestry with consciously intended behavior. Obviously things like our nervous system are on autopilot, and I fully concede that other aspects seem to be as well, such as various emotional triggers and behavioral / facial knee-jerk reactions (see Paul Ekman's <i>Emotions Revealed</i> for an interesting discussion to that end). I acknowledge the autonomy of such mechanisms, concede the relevance of our genetic and chemical predispositions, etc, but I maintain that there is still more to the story … more pieces to the puzzle … more cushion for the pushin' (well, maybe not that last one).
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Harris essentially makes two main arguments against free will, which taken together are quite formidable. I will summarize each and then bring the hellfire, but I encourage you to read Harris's full manuscript, as the author naturally goes into greater depth and explores other areas in addition to these.</div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif; text-decoration: underline;">Argument 1
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Experiments in neuroscience have shown that people do not become aware of the decisions they make until after those decisions are already made. If one is not aware of their decision until after the decision is made, one cannot be said to have made the decision in the first place.</div>
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Our thoughts and feelings drive our behavior. Introspection makes it clear that we do not choose our thoughts and feelings, but instead, simply experience them as they pop into our awareness. If we have no control over what we think and feel, then we have no control over our actions and behavior, and thus, no causal agency with respect to our lives at all. Since this is precisely the situation we find ourselves in, it follows that we do not possess free will.</div>
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<u>Response to Argument 1
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One would expect that our awareness of a decision would occur in conjunction with its formation. However, a variety of experiments involving EEG and fMRI monitoring of a subject’s brain have demonstrated that a subject's decision to move can apparently be anticipated prior to the subject consciously choosing to move (from 300 ms to as much as 10 seconds beforehand). The predicted movements in question are general in nature, such as the case of pressing a button. Note the predictive accuracy is not 100%, and scientists are not able to predict how a subject will press that button (e.g. with her index finger or her elbow), but this is arguably due to the infancy of the field.
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These findings are very intriguing and quite startling. However, it is important to realize that the duration of the time-lapse between subjects’ awareness of their choice, and the neuronal data that lead to successful predictions of that choice, is inconsequential. This is to say, whether those neuronal precursors occur 5 nanoseconds or 5 minutes before you feel like you’ve made the choice, both constitute a time-lapse. A greater time lag may very well be more shocking from a psychological standpoint, but philosophically speaking there is no reason why one duration should be more alarming than another. So it’s the time-lapse in and of itself that constitutes the real peculiarity - not the specific duration therein.
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Also, keep in mind that there is no brain scan technology that can tell us what you are thinking or aware of, so any assessment as to when a person consciously chooses to move can only be inferred, either from the subject’s behavior or from the subject’s first-person report. For example, your reaction to the smell of something rancid is what informs us that you've had such an experience - e.g. making a disgusting face, or stating "it smells like shit”. Of course, analyzing brain function can clue us in to the fact that you are thinking / experiencing in general, and seeing activity in the regions associated with our olfactory system can perhaps be indicative of the nature of that experience, but such activity will not tell us what specifically you are experiencing or thinking…we cannot conclude from a brain scan, "she's smelling petunias and thinking about streaking”. Maybe the future of neuroscience will one day be able to decode and translate the entirety of your brain, inclusive of the specific contents of your thoughts, but until that day comes we should tread carefully in reaching firm conclusions.
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The problem with indirectly deducing one’s awareness is that it leads to a great deal of uncertainty, and a person’s subjective self-assessment as to when they were conscious of a given thing is not precise enough for scientific standards. So attempts to study volition in the laboratory entail an unavoidably flawed protocol, wherein we cannot isolate a subject’s thoughts / intentions / awareness - only the totality of a person’s brain activity is accessible. The fact that a subject may feel as if he chooses to press a button at 1:15 PM, while a scientist is able to accurately predict that choice at 1:14 PM, is ambiguous in its implications: it could mean the subject did not cause the action (i.e. he has no free will), or it could mean there is some kind of disconnect between the subject’s awareness and his ability to integrate and report that awareness, or it could mean there is a confounding factor involved (e.g. the subject thought about the prospect of pressing the button without actually pressing it, which tipped off the neuroscientist). Furthermore, we can't determine if a movement, such as pressing a button, is encapsulated within one single choice, or is the product of multiple choices chained together (e.g. a decision to move, followed by a decision to move a finger, followed by a decision to commence the movement now); and if the latter, which decision in the chain is the true correlate of the EEG / fMRI readout and which decision correlates to the awareness being reported by the subject?
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So we find ourselves in muddy waters. Of course, we expect that we should be able to precisely pinpoint the inception of a choice in time. However, it’s interesting to speculate whether this expectation might actually be misguided - what if we are not sufficiently equipped, on a neurobiological level, to determine the precise moment of a choice? It seems to me that to accurately report when I make a choice, two things are required: 1) that I am capable of actually perceiving when the choice is made, and 2) that I am capable of remembering that information.<br />
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Regarding the first requirement, there are countless stimuli that occur too fast for our senses to perceive (e.g. movement of light photons), and perhaps thoughts are simply too fast for our awareness to pin down in time. But even if I can perceive this, I still have to store the temporal information associated with my choice into some kind of memory, in order to be able to reference and communicate that information to you. So is it possible that the time-lapse demonstrated within these experiments is suggestive of a deficiency in our capacity to remember when we make the decisions we make? <br />
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Our memories are certainly limited in a variety of other ways - you can’t remember what you were doing at 7:39 PM last July 2nd, and I can’t remember your name even though you told me five times. From an evolutionary standpoint, there certainly doesn’t seem to be any advantage to knowing the specific point in time that you decided to eat a berry, for example…only the choice itself and the consequences that follow would be important (e.g. I ate those berries and got sick). Perhaps our internal assessments as to when we make choices really are just retroactive educated guesses, not because we don’t actually make choices in the first place, but because we simply can’t remember when we made them. Maybe our brains do not possess the necessary circuitry to be able to process or retain this type of information, and human beings have some kind of permanent choice-amnesia. Maybe our heads would explode otherwise. And just ask yourself, how many people look at their watches and then have to look back a second time because they don’t remember what they just saw a moment ago? Think about it (but not too hard).</div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif; font-size: 12px; text-decoration: underline;">Response to Argument 2</span><i style="font-family: Helvetica;"><span style="font-size: 12px;"> _ </span><span style="font-size: x-small;">(you forgot what Argument 2 was, didn’t you? See what I’m saying? Well go back and reread it, you forgetful bastard)</span></i></div>
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I agree with Harris that simple introspection makes it obvious that we cannot account for the source of our thoughts and choices. Indeed, it appears as if thoughts come <i><u>to</u></i> us, as opposed to <i><u>from</u></i> us. Perhaps this explains the origin of phrases such as, “It just occurred to me that your stepson is an asshole”, or “the solution to the equation came to me last night in a dream”, or “It dawned on me this afternoon that I never looked underneath the mattress for her diary”. Regardless, the following line of inquiry is puzzling:
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Why did I do what I did? Because I chose to do it. Why did I choose it? I don’t know - I guess because I chose to choose it..(?) Why did I choose to choose it? Etc, etc. Final answer: I have no idea.
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We are woefully inadequate in answering this inquiry, because we have absolutely no idea why we think what we think. But on closer inspection, the fact that we don’t choose our thoughts may not be cause for alarm. After all, what would it mean to choose a thought? It would seem to involve having another thought! Argument 2 is framed in a way that assumes our thoughts need explaining, but in my opinion this is a mental / linguistic parlor trick. Moreover, our perplexity doesn’t go away in abandoning free will, and we could alter the inquiry accordingly:
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Why did I do what I did? Because of neurons firing in the brain. Why did those neurons fire? Because of other chemical / biological processes. Why did those processes occur? Because of yet other physical states and processes. And what caused those physical states and processes? Etc, etc. Final answer: The Big Bang. And what caused the Big Bang? … I have no idea.
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To the extent one investigates cause and effect, one will always encounter an infinite regress, or some amount of magic will enter the equation - either something must mysteriously arise from nothing without a cause, or there is a mysterious First Cause (wherein that First Cause has no cause or somehow causes itself), or something mysteriously just always is or was. At a fundamental level, cause and effect is baffling, and there are roadblocks at every turn.
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Although scientists don’t know how or why Existence came to be, we all agree that Existence exists nevertheless…in the same way, although we can't account for how or why we make the choices we make, we're making them nonetheless. We don't need to understand how or why something is, in order for that something to be the case. Of course, this is not a license to resort to wishful thinking, and it’s important to concede that Harris is not attempting to explain the metaphysics of choice - he's simply saying that whatever its nature, it's not us doing the choosing. However, this does not resolve the enigma at hand, but simply moves it to a different arena wherein the enigma persists, and without providing an intelligible explanation as to the fundamental source of our thoughts, Argument 2 essentially just amounts to an acknowledgement that we are completely in the dark about the matter. We didn’t know what was going on before Argument 2, and we still don’t know what’s going on after Argument 2. It may be tempting for some to suggest that the Big Bang being responsible for our thoughts and choices is somehow less mysterious compared to that of free will, but pushing a mystery back billions of years doesn’t make it any less of a mystery - it just keeps it out of sight. It’s smoke and mirrors.
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Perhaps this bafflement is the result of asking what in truth are meaningless questions. Philosopher Alan Watts (along with various Eastern worldviews) would suggest that this discussion of cause and effect and free will assumes that we are independent minds acting on the world, when in fact we are not (see <i>The Book</i>). Watts would argue that the real illusion is that there are separate things at all; that through your narrowed consciousness you appear to be a separate thing, but in truth, you and every thing that you think is not you are all part of one process of being, as the wave is one with the ocean. From this perspective, no one is choosing and no one is not choosing - We / I / You / It are just being.
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Interestingly enough, consider this: I identify myself as the summation of my mental happenings…I am what I think and feel. If all of my thoughts and feelings stem from a nebulous source outside of me, then wouldn’t this just mean that my sense of “me” is illusory, and not my sense of autonomy? In other words, if I am that which thinks and feels, but something else is doing the thinking and feeling, then aren’t I whatever that something else is? And if that something else is bound within an infinitely regressing causal chain of events, then aren’t I the entirety of that chain? And if you and everyone else are similarly such things, and we all originate from a single point at the beginning of Time amidst a mystical explosion of something from nothing, then … that would mean We / I / You / It are simply Being.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkpWOQyK9AqbIlaVaWq9E8q9biQ7NISy82NWbm9tlgOhqiSrJ4ESTjN6SCdvHMWAH_4i_B8LP57psOoK7mBpYDsJQn1hlK18MBXzkqjSKIuEBbKSGaQp0_EudkC1tUaQoJ7OAKZaDH4Z-Y/s1600/Mind-Blown.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="516" data-original-width="412" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkpWOQyK9AqbIlaVaWq9E8q9biQ7NISy82NWbm9tlgOhqiSrJ4ESTjN6SCdvHMWAH_4i_B8LP57psOoK7mBpYDsJQn1hlK18MBXzkqjSKIuEBbKSGaQp0_EudkC1tUaQoJ7OAKZaDH4Z-Y/s320/Mind-Blown.jpg" width="255" /></a></div>
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With or without free will, we can’t account for why we think what we think. So it comes down to the following: either we are arbiters of our own destiny, making legitimate decisions about what we do and don't do, along with real choices as to how we act and behave…or we are captives, trapped within bodies, aware of ourselves but without causal agency, at the complete mercy of thoughts and feelings that are not our own. Like the Highlanders that came before us, there can only be one. So which one is it? You decide (to the degree that you can).</div>
<br />Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com15tag:blogger.com,1999:blog-801873645877244873.post-45410100387010361302013-11-09T13:57:00.000-05:002017-06-09T18:03:00.034-04:00BRAAAM 101
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Three years after Mind Heist appeared in a trailer for the movie Inception, people still seem to be thoroughly confused with respect to "who created the BRAAAM". A slew of forums and various online publications regularly seem to discuss and debate this issue. So let's take a moment and clear this up.</div>
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BRAAAMs have been around long before Mind Heist and Inception, and they will be around long after. What is a BRAAAM? It's when a note (usually a low note) is performed by a large number of instruments very intensely. Technically, you could call it a fortissimo in unison. Non-technically, it's popularly referred to as a BRAAAM.</div>
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What differentiates one BRAAAM from another BRAAAM has to do with the nature of its construction and the context in which it occurs. The BRAAAMs in Mind Heist and the other incarnations that have occurred in symphonic / film / trailer / electronic music are each comprised of various ensembles. Some of the elements that make up the ensemble may be commonly used (e.g. brass), while other elements may be more unique (e.g. unicorn howling). It's how these elements get blended together that gives each BRAAAM an identity. Kind of like snowflakes.</div>
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But the most important distinguishing factor is context. If Mind Heist were comprised of just the BRAAAM by itself, it would have been musical sound design rather than music. But alas, Mind Heist is a song that <i>has</i> BRAAAMs, rather than a song <i>of</i> BRAAAMs. And if the song itself was not compelling, the BRAAAMs would not have mattered. This is to say, the song's composition and production (melody, harmony, rhythm, orchestration, mixing, mastering) is what makes it compelling - the BRAAAMs were simply one feature, albeit a prominent one. Kind of like when someone meets a wonderful woman, but only talks about her boobs. Sure, Mind Heist has big boobs, but she's also got an amazing personality. Hey, eyes up here.</div>
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Interestingly, the "breasts of Mind Heist" (I smell a remix) were made more prominent within the Inception trailer, partly as a result of trailer producers / editors / mixers that skillfully paired the visual and audio components, and partly due to the general 2 minute length of the theatrical trailer format. While much library music conforms to that length, most songs exceed it. This means that most of the songs that get used in trailers (including Mind Heist) get edited down by necessity, and thus, the Mind Heist used in Inception's trailer is actually an abridged version of a larger work (see <a href="http://www.youtube.com/watch?v=lCGlIjLT8OQ" target="_blank">Mind Heist: Evolution</a>).</div>
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Now as for another commonly held misunderstanding regarding Mind Heist … I've never met, spoken to, corresponded, snorkeled, canoed, parachuted, finger-painted, or otherwise collaborated with the composer or director of the film Inception.</div>
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So what have we learned today? That a BRAAAM is a musical device, used since time immemorial. This musical device was utilized within Mind Heist and the Inception trailers / film, and although largely popularized as a result, was not invented therein. There is no "creator" of BRAAAM. There are only users of BRAAAM. And some even say we are all made of BRAAAM and one with BRAAAM. Deep.</div>
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Class dismissed!</div>
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<i>bum, bum, bum, bum, ba da bum, bum, bum….</i><span style="font: normal normal normal 12px/normal Arial;"><i>BRAAAM</i></span></div>
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<br />Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com8tag:blogger.com,1999:blog-801873645877244873.post-75430922147595833312013-09-19T21:12:00.001-04:002017-06-09T18:02:40.656-04:00MMA - It's A Fight, Not A War
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There is a tendency within mixed martial arts to refer to amazing or epic fights as "wars". Commentators, journalists, and dudes sitting in their living room are all apt at some point during an MMA event to exclaim, "what a war" or "this guy is a warrior" or "those two just went to war" or something similar. Am I really the only one that finds this metaphor misconceived? Call me crazy, but until tanks start rolling into the UFC's octagon, and combatants and spectators start wearing helmets to protect themselves from explosion debris and stray bullets, a fight could not be further from a war. A fight takes place in a controlled atmosphere with rules, regulations, and a referee to prevent either fighter from getting seriously maimed or killed. A war denotes armed conflict and entails the deaths and killing of many people. Maybe you can get away with referring to a fight as a "battle"…maybe…but why can't it just be what it is? It's a fight - is that so underwhelming? </div>
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I fully acknowledge that I am making a big deal about nothing here, somewhat akin to pondering the existential implications of the question, "Got Milk?", but for whatever it's worth, I think it's healthy to occasionally ponder the innocuous things in life (and to that end, can one ever really <i>have</i> milk? For if you consume it, does it not ultimately leave you? If you cup it, does it not seep through your fingers? Does it not go bad with time? And even with respect to the gallon of milk that you "have" in your refrigerator, in reality don't you in fact have a gallon jug that has milk?). </div>
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Now back to war. Is MMA violent? Absolutely. But there is a big difference between a violent sport and mortal combat. Are MMA fighters tough? No question. Can an MMA fighter have a "warrior's spirit"? Sure. But until Genghis Khan or The Last Of The Mohicans step into the UFC, let's hold off on dubbing the contestants "warriors". We don't need to mythologize them, and we don't need to convince ourselves we're watching a modern day fight to the death inside the Colosseum - it's a goddamn fight, and that's all it needs to be. </div>
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In truth, I think metaphorical use of "war" occurs without consideration of the word's literal meaning. Consider the hypothetical use of the word "rape" in the same context. Imagine a commentator exclaiming, "Wow, McCreary just totally raped that guy - complete domination!" Or, "every time Oswald steps into the octagon, he rapes and pillages his opponents". One could understand how it would come off as insensitive, distasteful, and just plain inaccurate. I caution that we not repeat this same error in judgement with respect to the use of "war" in MMA. </div>
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Now, it should be noted that there are some MMA fighters who actually have been in combat, or served in the military, or lost loved ones to the horrors of war - and some of these individuals have utilized the "war" metaphor - but their intimate familiarity with that word affords them the right to use it however they wish, in my opinion. I would also like to make it clear that it is not my intention to scold anyone for using this metaphor…I'm simply asserting that it's use is without merit. Moreover, I think many trends of political correctness frequently suffocate communication, are ridiculous, and have been going on for far too long - people are way too sensitive about everything, and it needs to stop. So I am not suggesting that the war metaphor is a plight on the sport of MMA that needs to be expunged, or that those who utilize the analogy are disrespectful people - I just think the metaphor is unnecessary and ill-suited (unless there is an MMA body count that I'm unaware of, or un-televised UFC drone strikes secretly taking place).</div>
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On a final note, if we really want to break it down, even using the word "fight" may be misguided to the extent that one associates that word with a no holds barred situation. In this sense, UFC "fights" are really "competitions". But even though there is a big difference between an actual street fight (where anything goes and the motivations and intent of the participants are without mercy) and a ring fight (that takes place in a controlled environment with rules and regulations), note that "street fight" and "ring fight" both contain the word "fight", and therefore, I think we can safely continue to call MMA fights "fights".</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com4tag:blogger.com,1999:blog-801873645877244873.post-24571675555623347532013-08-10T09:27:00.000-04:002017-06-08T15:47:30.370-04:00What You Need To Know About Infidelity and Mate Selection<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
Discussions about human behavior are often rife with ridiculousness. A good example of this is with respect to infidelity. I can't tell you how many conversations I've been a part of where someone conclusively states that all men cheat (some just don't get caught, or don't have the opportunity, or whatever). According to these specialists, male infidelity stems from a genetic imperative to spread their seed. Although sexual drive in and of itself is biologically programmed, this has nothing do with who we choose to sleep with (or how many). I think a far more likely explanation for male infidelity is that sex feels good and is quite enjoyable, inclining men (some men) to pursue it unabashedly. Some men are addicted to alcohol, and some are addicted to boobs. Of course, some view women as sport and appear to experience an unnerving high upon "conquering" a woman, as if they had just taken the beaches of Normandy or something. However, I think the majority of unfaithful men just like to fuck a lot. </div>
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But here's a revelation: women have an equal propensity for infidelity. Yes that's right - women like to fuck too! The stereotype of men following the whims of their penis while stalwart women are immune to the compulsions of desire is quite simply false. Ashley Madison anyone? I believe it was Albert Einstein who proved that it takes two to tango.</div>
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Some cheat because they don't love their partner (and maybe never have). Some cheat because their partner is about as interested in sleeping with them as with going back to work on Monday. Some cheat for the physical sex. Some for the intimacy. Some for love. But some people don't cheat…maybe because the appeal of sex with another person is outweighed by the potential hurt their partner will feel upon finding out, or because of social stigma, or because sex with a stranger is far less gratifying in reality than it is in fantasy, or because they simply don't feel the need to have intercourse with everyone. The point is that not everything comes down to genetics.</div>
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Similarly, consider mate selection. It is commonly believed that a woman's primary concern in life is security, and consequently, that she will seek a mate that has either wealth, status, influence, or something else along those lines - someone who will provide a safe and stable environment. This may very well be…for some women. And guess what? For some men too! All humans feel vulnerable. Despite the adrenaline-craving junkies of the world, no one actively strives to live in an unstable, inhospitable, uncaring, or dangerous environment. Well, maybe no one apart from those depicted in the show Mountain Men, however even they feel secure in their way of life. But make no mistake - some women prefer the mate that makes them laugh over the mate with the stable job, some prefer the amazing lover over the wealthy businessman, and some would rather struggle on their own than suffer the banality of their secure life with the snow globe salesman.</div>
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The bottom line is, there are a lot of variables that go into a person's makeup and behavior - their thoughts, feelings, upbringing, moral compass, life experience, the presence or lack of a conscience (4% of people apparently don't have one), their innate nature and/or genetic proclivities, and probably a bunch of other things I'm not aware of. In short, we're not all built the same. So let's all agree to stop generalizing each other…except for blondes, because it's been scientifically proven that people with yellow hair really are dumber.</div>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com2tag:blogger.com,1999:blog-801873645877244873.post-52825492925226421542013-07-12T20:27:00.000-04:002017-06-08T15:46:41.094-04:00What You Need To Know About A Man's Shoes<div style="font-family: Helvetica; font-size: 12px; line-height: normal;">
I was once told that the first thing women look at on a man are his shoes. This was said to me by a woman, just so we're clear, and according to her everything you need to know about a man can be discerned from this one item. Apparently, a man's footwear is the summation of his entire being. After she said this to me, I remember thinking "that's fucking stupid," but I didn't want to be rude so I remained silent. Fortunately, at the time of receiving this insight I was actually wearing flip flops, so I was thankful to have evaded her penetrating analysis (or could it be that she was analyzing my toes???!!!???). Regardless, now that many years have passed and this woman has long forgotten me, I think it's finally safe to come forward.</span><br />
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Here's what I think a man's shoes tell you about the man: nothing. It's not that a person's shoes don't reflect who they are - it's that there are a multitude of traits and characteristics to which a given pair of shoes could potentially allude. If a man is concerned with his image, his attire will certainly reflect that, and in turn, his shoes will probably look snazzy. But then the question is, why is he concerned with his image? Maybe such concern stems from his line of work and how he is perceived by his associates. Or, maybe he's simply an ego maniac who is obsessed with his image. So for those tempted to automatically conclude that a man with snazzy shoes is a respectable individual who takes pride in himself, always remember to consider the alternative possibility that he only cares about looking good and doesn't actually give a shit about you.</div>
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Taking another example, if a man is a complete mess in life, then his shoes may indeed be a mess as well. But slow it down Speed Racer, because embarrassing footwear could also be indicative that he's got larger priorities in life - maybe he spends his days volunteering at homeless shelters and simply doesn't have an interest in looking spiffy this evening. Moreover, don't discount the possibility that some may intentionally adorn a pair of shoes as a means of deception…that individual wearing Christian Louboutin red bottoms may not be as upscale as he appears, and for all you know those shoes may even trace back to a corpse in the trunk of a car somewhere (and this person is about to cut out your pancreas as soon as you get back to his place).</div>
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As a final example, if a man is wealthy, then he will very likely have nice and expensive shoes. But don't start fawning when you see a man with nice shoes out and about - for all you know, the money he spent on his shoe collection should have gone to paying the child support. How many wealthy scumbags can you think of?</div>
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I trust we all get the picture. In case anyone thought otherwise, the above is equally applicable to female footwear. And the same principle applies to suits, cars, and other items of status. Things are just things. Nothing more. In and of themselves, they can't tell you anything definitive about a person's past, present, or future standing, and they certainly can't tell you anything about the content of a person's character.</div>
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FYI, when it comes to me personally, I buy a new pair of shoes once my current footwear begins to get holes in them. What does that say about me?</div>
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<br /></div>Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com7tag:blogger.com,1999:blog-801873645877244873.post-13337380701173672432013-05-27T11:02:00.000-04:002017-06-09T18:02:16.741-04:00What Are The Chances?
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I'm not sure how many of you have experienced synchronicity, but I can tell you that when it happens, it's quite mind-boggling. A classic example is that of the famous mythologist and writer Joseph Campbell, who after reading about the praying mantis opened up a window in his 14th floor apartment building located in New York City, only to find…a praying mantis staring at him.</div>
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As to if such cases of synchronicity are completely coincidental, or meaningful in a deeper sense, I cannot say. Perhaps synchronicity is bound to occur, given enough time, within the complex interaction of laws, chance, and probability that blanket the universe…perhaps our very existence is the prime example of synchronicity. Or perhaps there are unseen forces at work - forces which we may or may not contribute to, but to which we are nevertheless connected and influenced by - forces that shape and guide the trajectory of our lives like a hidden hand arranging life's puzzle pieces. </div>
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I'm going to abandon attempts at explanation, and instead, simply add my recent experience to the annals of synchronicity.</div>
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My good friend Omead Afshari, designer extraordinaire and lord of the male belly dance, recently became a teacher at Carver Center for the Arts located in Maryland. He's in the midst of his first school year, and since September of 2012 has been trying to persuade me to come to his school and speak to some of the students. Well earlier this month, I decided to drive down to Maryland from New York and pay my friend a visit in his native land. So of course, I also visited the school and spoke to a few different classrooms. The students were all awake and attentive, so I must have been doing something right.</div>
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The school day came to an end, and as it turned out, a dance performance was scheduled to take place an hour later in the main lobby. Sounded interesting, so we decided to hang around for it. After two performances, the dance instructor invited everyone to the dance studio for additional performances. Omead and I debated whether to abandon ship at that point, given we had an engagement to attend in less than two hours. But we threw caution to the wind and proceeded to the dance studio, wherein we were handed a program that seemed to suggest there were going to be an additional 15 dance performances taking place. Now we were seriously considering abandoning ship, but ultimately our interest endured and we continued to stand fast.</div>
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At the start of the 2nd to last performance, the dancer walked onto the stage and the music began. Omead immediately turned to look at me, jaw agape. "Am I hearing what I think I'm hearing" he asked? Yep. It was my song "See What I've Become". This confirmation sent him into a mental tailspin, and he stressed that he had nothing to do with it, and that the students picked their own music for these routines. Then during the Q&A after the show, he stood up and let the cat out of the bag: "I'm a teacher here and I just want to say that art has a strange way of connecting people. In the 2nd to last performance, for example, the person who made that music happens to be a good friend of mine…and he happens to be here right now" [cue American Idol screams and applause].</div>
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So to my mathematics and statistics friends, consider this: I drive to Maryland from New York for an impromptu school visit, on a random day of no significance, a day in which there happens to be a dance performance taking place after school, a performance which I happen to choose to attend (despite two separate considerations of leaving), during which one of the performances happens to be done in concert with my song. What are the chances? I've never stayed in Maryland prior to this, nor had I ever spoken at a school before, and Omead had no interaction or communication with the dance instructor or dancers (located on the opposite side of the building)…moreover, I'm no Justin Timberlake with respect to popularity; my music is not on the radio, nor is it affiliated with a label or part of a PR machine, and my album sales are so far from platinum they ought to be considered aluminum. Things get even spookier when you consider the fact that the dance students apparently received their assignment to choreograph and perfect a routine for this show about 2 to 3 weeks beforehand - which is just about when I had called Omead to tell him I would be visiting him in a few weeks.</div>
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Be on the lookout friends, for things are in motion.</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com15tag:blogger.com,1999:blog-801873645877244873.post-48497601669039204032013-01-31T20:35:00.000-05:002017-06-09T18:01:48.486-04:00More Room Treatment, Anyone?<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;">
At various points in my career, I've had the privilege of working in some pretty appalling acoustic environments - untreated rooms, un-sound-proofed rooms, even an untreated and un-sound-proofed studio with 8 windows, across the street from a major highway (yikes!). Although such conditions unquestionably pose severe obstacles in the way of music production and mixing, I believe that where there is a will there is a way, and that the creative spirit can miraculously overcome such handicaps (provided the music ends up in the hands of a good mastering engineer). That being said, working within an "accurate" acoustic environment immeasurably increases the effectiveness of one's mixing, and allows for a more informed decision process during production, since one can hear things that are actually present in the music, without being influenced by acoustic anomalies and illusions created from the way in which sound waves bounce throughout the room. So every audio professional naturally seeks to take the room out of the acoustic equation.</div>
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Thus, when I built a new studio back in 2011, I was determined to make it as accurate of a listening environment as I possibly could. My philosophy has always been to go big or go home - and seeing as my studio was located within my house, I was already home, which meant I had no choice but to go big.</div>
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Built from the ground up with my own two hands (along with those of a master carpenter, who actually knew what he was doing), my new room wasn't fancy in its dimensional layout, but it had an isolated ground and dedicated circuit breakers, so I was off to a good start - that is, until the first listening test made it clear that things were afoul, acoustically speaking. So I installed some acoustic room treatment. Then I installed more room treatment. Then a bit more. And then a little more. I upgraded speakers, <a href="http://zackhemsey.blogspot.com/2011/12/how-to-single-handedly-unload-subwoofer.html">added a subwoofer</a>, upgraded converters, lowered the noise floor, and replaced one kind of acoustic treatment with another kind. The results were great, but my expectations were those of a mastering engineer's standard, which meant there could be no compromise. So I bought a little more treatment. I experimented with speaker placement, listening position, treatment layout, etc. I took sound frequency measurements, calibrated speakers, compared results, and acted the part of a trained acoustician. I measured physical distances with a tape measure and nodded contemplatively. Then I expanded my studio with the addition of various mastering equipment and outboard gear…and then I bought more treatment. I moved this there, and that there, and ultimately created a database of over a hundred different layout orientations with their corresponding frequency measurements for each speaker - then I had the lab tech (me) analyze the results. </div>
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After extensive research and analysis, and countless listening tests, when it was all said and done I thought to myself, "damn, that sounds good". Have a look at the pictures below - this may be the very definition of sexy (okay, granted it's not a multi-million dollar facility crafted from melted down platinum and gold records, but hey, sometimes it's the unassuming girl that turns out to be the hottest).</div>
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Now, it should be noted that too much acoustic absorption in a room can become less than ideal, depending on the size of the room and the type of absorption. In this case, more than half of the treatment in this room is low frequency focused, which is to say, does not affect the high end (generally speaking, one can never really have too much low end absorption). As such, this studio has a tight sound, but not a dead sound. And with so many mysterious looking pillars, there's potential for some enthralling LSD experiences (acoustically accurate LSD experiences, of course).</div>
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It should also be noted that the term "accurate" is a bit misleading within the context of acoustics. Theoretically, an accurate frequency response would be that of a flatline, with no frequency bumps or dips along the spectrum. But as it turns out, actually getting a flatline is rather impossible; and what's more, you probably wouldn't even want it if you could have it, which brings up the non-technical side of accuracy…namely, that there is a degree of subjectivity to tuning a room, and that every room invariably has its own "sound" or "vibe". So while one should chase the flatline in principle, all technical findings and decisions must be weighed against subjective perception and taste (making for an interesting catch-22).</div>
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Lastly, I'd like to draw attention to the thin piece of tissue hanging from the ceiling above the computer monitor. This tissue paper is the single most important aspect of the entire room, the very corner stone of the studio in fact. It does not serve an acoustic function, but rather, prevents the light source from blinding the person in the central listening position…because if there's one thing I learned in all my efforts to realize the perfect listening environment, it's this: when there's too much light shining in your eyes, you can't hear anything accurately.<br />
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<span style="font-family: helvetica; font-style: italic; text-align: start;"><b>UPDATE 10/10/14</b>: The studio has been completely restructured - see </span><a href="http://zackhemsey.blogspot.com/2014/10/rome-wasnt-built-in-day-and-neither-was.html" style="font-family: helvetica; font-style: italic; text-align: start;" target="_blank">here</a><span style="font-family: helvetica; font-style: italic; text-align: start;">.</span></div>
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Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com18tag:blogger.com,1999:blog-801873645877244873.post-4686852258884779702012-12-30T03:05:00.000-05:002017-06-09T17:50:46.920-04:00Quotations and Punctuation...I'm going rogue.
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American grammar is quite goofy when it comes to how punctuation interacts with quotations. The placement of the period in the following sentence is said to be grammatically correct:</div>
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1A) George threw out his socks, claiming they were "poisoned."</div>
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Does the placement of that period look blatantly wrong to you as well? I contend the following should be considered correct:</div>
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1B) George threw out his socks, claiming they were "poisoned".</div>
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Here's an alternate example:</div>
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2A) Cindy explained, "It's his baby, not yours."</div>
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Compared to:</div>
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2B) Cindy explained, "It's his baby, not yours".</div>
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Now check out the following examples, both of which are considered grammatically correct with respect to the placement of the question mark:</div>
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3) After slipping in the aisle, Gunther inquired, "Who the fuck put lubricant all over the floor?" </div>
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4) Was Tammy correct when she claimed, "the three things that never stop growing on a man are his ears, nose, and testicles"?</div>
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The sensibility of question mark protocol is encouraging, but we're not out of the woods yet. Consider two final grammatically correct examples that throw more chaos into the mix with respect to the placement of commas and periods:</div>
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5) Out of a possible "10", Haley's breasts would have to be considered a "12".</div>
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6) Jared wasn't "feeling well," so he put the dildo in the box marked with an "X".</div>
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So in summary, this is a complete clusterfuck, and frankly I'm not going to stand for it. From this point forward, I'm going to place all periods as the last item in a sentence, and the quotes can go "fuck themselves".</div>
Zack Hemseyhttp://www.blogger.com/profile/15583382768263193839noreply@blogger.com6