The Starting Gate: Birth Weight and Life Chances
http://www.100md.com
《新英格兰医药杂志》
Written from a social-science perspective, this book deals with the causes and consequences of low birth weight (less than 2500 g). Using low birth weight as an example, the book addresses the "overstated separation between nature and nurture by considering how society, biology and genetics interact." To dissect the social and environmental causes of low birth weight from genetic and biologic factors, the problem must be analyzed across generations, which the book does comprehensively. One of the main assumptions is that the influences of race, class, society, and biology on low birth weight can be explained most effectively by looking back at previous generations.
The interaction among such factors as race, class, health, and socioeconomic status is handled sensitively as the authors explore the reasons behind the high incidence of low birth weight among blacks. The illustrative examples are thought-provoking. For instance, two groups of couples — one high-income and one low-income — might have a 20 percent biologic predisposition for having a low-birth-weight baby, but the parents in the high-income group who have resources for better nutrition and prenatal care might counteract their biologic tendencies and have fewer low-birth-weight babies.
I have minor criticisms of the book on the basis of factual information (in the United Kingdom, viability is deemed to start at 24 weeks, not at the stated 28 weeks) and terminology (e.g., prematurity, immaturity, and preterm). Although the authors clearly understand the need to categorize low-birth-weight infants as either appropriate for gestational age (but born prematurely) or small for gestational age, they choose not to use this recognized terminology. The section that deals with studies of mixed-race infants appears to support the theory that genetic differences between blacks and whites play a role in low birth weight. Regardless of socioeconomic status, mixed-race infants generally have birth weights that fall between those of the offspring of two white parents and of two black parents. The incidence of low birth weight among mixed-race infants (relative to those with two white parents) is twice as high when the father is black as it is when the mother is black, a finding that suggests that each parent contributes race-specific genes to birth weight (the father through genetics, the mother through a mixture of genetics and environmental and uterine factors). However, these different risk profiles could result from different social and biologic profiles of the couples in question and not only from genetic differences.
The text occupies 60 percent of the book, with 40 percent devoted to appendixes, references, tables, and a comprehensive bibliography. Even though The Starting Gate is not a reference textbook, it is a challenge to read — not through any lack of clarity but because of the complex interplay of confounding variables affecting conclusions. It should be digested in small, bite-size portions over time.
Ronald F. Lamont, M.B., Ch.B., D.M.
Imperial College
London HA1 3UJ, United Kingdom
pauline.mills@nwlh.nhs.uk(By Dalton Conley, Kate W.)
The interaction among such factors as race, class, health, and socioeconomic status is handled sensitively as the authors explore the reasons behind the high incidence of low birth weight among blacks. The illustrative examples are thought-provoking. For instance, two groups of couples — one high-income and one low-income — might have a 20 percent biologic predisposition for having a low-birth-weight baby, but the parents in the high-income group who have resources for better nutrition and prenatal care might counteract their biologic tendencies and have fewer low-birth-weight babies.
I have minor criticisms of the book on the basis of factual information (in the United Kingdom, viability is deemed to start at 24 weeks, not at the stated 28 weeks) and terminology (e.g., prematurity, immaturity, and preterm). Although the authors clearly understand the need to categorize low-birth-weight infants as either appropriate for gestational age (but born prematurely) or small for gestational age, they choose not to use this recognized terminology. The section that deals with studies of mixed-race infants appears to support the theory that genetic differences between blacks and whites play a role in low birth weight. Regardless of socioeconomic status, mixed-race infants generally have birth weights that fall between those of the offspring of two white parents and of two black parents. The incidence of low birth weight among mixed-race infants (relative to those with two white parents) is twice as high when the father is black as it is when the mother is black, a finding that suggests that each parent contributes race-specific genes to birth weight (the father through genetics, the mother through a mixture of genetics and environmental and uterine factors). However, these different risk profiles could result from different social and biologic profiles of the couples in question and not only from genetic differences.
The text occupies 60 percent of the book, with 40 percent devoted to appendixes, references, tables, and a comprehensive bibliography. Even though The Starting Gate is not a reference textbook, it is a challenge to read — not through any lack of clarity but because of the complex interplay of confounding variables affecting conclusions. It should be digested in small, bite-size portions over time.
Ronald F. Lamont, M.B., Ch.B., D.M.
Imperial College
London HA1 3UJ, United Kingdom
pauline.mills@nwlh.nhs.uk(By Dalton Conley, Kate W.)