It's a Miracle--Not!

February 27, 2006

The Pax Cable Television Station had a show called It's a Miracle purporting to report on real miracles. This particular episode concerned a family who adopted a so called "crack" baby that miraculously turned out to be fine despite the damage the prenatal cocaine exposure allegedly caused. As the published letter below explaines, this child’s health and success despite prenatal exposure to cocaine is not a miracle. Scientific data has long demonstrated that cocaine does not cause the devastating problems portrayed generally in the media and specifically by this television show. What was a real miracle was our victory in United States Supreme Court in the case of Ferguson v. City of Charleston recognizing that hospital patients, including drug using pregnant women, don't lose their Fourth Amendment constitutional rights when they seek health care.

To Whom it May Concern:

Some weeks ago, I saw an episode of It’s a Miracle concerning a family who adopted a so called "crack" baby and had miraculous success raising that child despite the damage the prenatal cocaine exposure allegedly caused. This child’s health and success despite prenatal exposure to cocaine, however, is not a miracle. Scientific data has long demonstrated that cocaine does not cause the devastating problems portrayed generally in the media and specifically by your television show.

The most thorough and comprehensive scientific survey to date, assessing the impact of maternal cocaine use on pregnancy outcomes and child development, and published in the prestigious Journal of American Medical Association, fails to link in utero cocaine exposure with chronic, adverse consequences. See Deborah Frank et al., Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure: A Systematic Review, 285 JAMA 1613 (2001). See also Wendy Chavkin, Cocaine and Pregnancy -- Time to Look at the Evidence 285 JAMA 1626 (2001).

Although this research and commentary represents the latest and most comprehensive review of the scientific evidence, data has long been available demonstrating that the problems the child in your show faced cannot be attributed to exposure to cocaine.

In 1992, almost a decade ago another article appearing in the Journal of the American Medical Association concluded that:

review of the current literature on the subject [of the adverse effects in infants born to cocaine-using mothers] indicates that available evidence from the new born period is far too slim and fragmented to allow any clear predictions about the effects of intrauterine exposure to cocaine on the course and outcome of child grown and development. . . . Findings about neurobehavioral effects in the newborn period have been inconsistent or contradictory. Significantly, no prospective study of unique long-term consequences of intrauterine cocaine, non-opiate exposure has been published in the peer-review literature.
Linda C. Mayes, et al., The Problem of Prenatal Cocaine Exposure: A Rush to Judgment, 267 JAMA 406 (1992). More to the point researchers as early as 1993 observed:

Children exposed to cocaine prenatally . . . have been portrayed in the popular media as inevitably and permanently damaged . . . [T]he public outcry for the punishment of substance-using mothers and the disenfranchisement of their children as unsalvageable almost demonic "biologic underclass" rests not on scientific findings but upon media hysteria fueled by selected anecdotes.
See Deborah A. Frank, et al., Maternal Cocaine Use: Impact on Child Health and Development, in 40 Advances in Pediatrics 65, 92 (1993). See also in 1993, a publication of Harvard Medical School reported that a "1991 combined analysis of 20 studies on cocaine and pregnancy found few effects that could be specifically attributed to cocaine." Update on Cocaine: Part I, 10 Harv. Mental Health Letter (Harv. Med. Sch.), Aug. 1993 at 3; E. Hutchins, Drug Use During Pregnancy, 27 J. of Drug Issues 463, 465 (1997) (emphasis added) ("[k]nowledge concerning the biological effects of cocaine exposure on the newborn is inconclusive at present."). Putting it even more bluntly, other researchers concluded:

The "crack baby" on which drug policy is increasingly based does not exist. Crack babies are like Max Headroom and reincarnations of Elvis ... a media creation. . . . babies exposed to [cocaine] prenatally do not exhibit symptoms of drug withdrawal.
Other symptoms of drug dependence --such as "craving" and "compulsion"-- cannot be detected in [cocaine exposed] babies. In fact, without knowing that cocaine was used by their mothers, clinicians could not distinguish so-called crack-addicted babies from babies born to comparable mothers who had never used cocaine or crack.

John P. Morgan and Lynn Zimmer, The Social Pharmacology of Smokeable Cocaine, Not All It’s Cracked Up to Be, in Crack in America: Demon Drugs and Social Justice 131, 152 (Craig Reinarman & Harry G. eds., 1997).

Your show purports to tell true stories. But, suggesting that prenatal exposure to cocaine inevitably causes the kind of problems that the child in your program experienced is simply not supported by the medical evidence. Therefore, I urge you to refrain from re-broadcasting this episode unless the false information concerning cocaine is deleted in future presentations.

While it is certainly true that pregnant women should, if possible, avoid a wide range of substances including cocaine, tobacco, alcohol and aspirin, false and alarmist reports specifically about cocaine’s effects have lead to consequences that have been devastating for both women and children. Among these are thousands of children labeled "crack kids" who are teased, humiliated and treated as somehow damaged or incompetent, when in fact they are beautiful, talented and healthy children. False information has also resulted in the arrest and prosecution of the pregnant women and new mothers who desperately needed and wanted appropriate treatment for their health problems.

Indeed, in 1989, one hospital, the Medical University Hospital in Charleston, South Carolina, ("MUSC") worked in collaboration with the police and solicitor’s office to develop a policy of searching certain pregnant women for evidence of cocaine use, reporting that use to the police and Solicitor’s office, and facilitating the in-hospital arrest of pregnant women and newly delivered mothers. In 1989 there was not a single drug treatment program, in or outpatient that existed in South Carolina to provide treatment for pregnant women or new mothers. MUSC’s own drug treatment program within its Institute of Psychiatry refused admission to pregnant women.


Under the test and arrest policy, women were selectively searched through urine drug screening, for evidence of cocaine use. If they tested positive they were dragged out of this predominantly black hospital in chains and shackles. The consequences for the women were severe:


One patient had been receiving prenatal care at MUSC. When she went in for medical help in her eighth month of pregnancy, the policy was now in place. She was searched through a urine drug screen, and when it indicated that she had used cocaine she was not offered medical help for this medical problem, instead she was taken to jail in chains and shackles. Bail was deliberately set too high for her to obtain release. She spent the next three weeks in the prison sick bay. Because of her condition she was frequently transported, in handcuffs and chains, to MUSC where one leg would be unchained at a time to permit medical examination. During her two days of labor and much of her delivery, she was shackled to the hospital bed.


Another plaintiff received prenatal care at MUSC before the policy was implemented; she was never offered drug treatment. She gave birth to a healthy child who tested positive for cocaine shortly after the policy started. When her two older sons came to take her home from the hospital, she was instead arrested right in front of them. The patient, still dressed only in her hospital gown, was taken away, still bleeding and in pain from childbirth.

We challenged the policy in a federal civil rights suit. Despite overwhelming evidence of harm and discrimination we lost at trial. We lost again on appeal. At that point our only recourse was to seek review from the United States Supreme Court. The Supreme Court gets asked to review approximately 7,000 cases a year, but only takes about 90. My esteemed co-counsel and colleague on the case is a part time minister. She prayed that the Court would take the case. I think all of us, plaintiffs, lawyers and volunteers, who had been involved in the case for nearly a decade each prayed in his or her own way. Despite the enormous odds the Court, not only took the case, but in the end we won. Now that is a Miracle! See Ferguson et. al. v. City of Charleston et. al., 121 S. Ct. 1281 (2001)


Also miraculous are the women who despite extreme poverty, violence and social systems that in practice often obstruct recovery, have nevertheless managed to overcome or reduce their drug use and keep their families together.


I hope in the future, your inspirational program will stick to its mission of reporting true miracles, instead of exploiting the crack baby myth and repeating prejudicial medical misinformation.


Sincerely,

Lynn M. Paltrow Executive Director, National Advocates for Pregnant Women