March 3, 2009
Basics
In a Helpless Baby, the Roots of Our Social Glue
By NATALIE ANGIER
In seeking bipartisan support for his economic policies, President Obama has tried every tip on the standard hospitality crib sheet: beer and football, milk and cookies, Earth, Wind and Fire.
Maybe the president needs to borrow a new crib sheet — the kind with a genuine baby wrapped inside.
A baby may look helpless. It can’t walk, talk, think symbolically or overhaul the nation’s banking system. Yet as social emulsifiers go, nothing can beat a happily babbling baby. A baby is born knowing how to work the crowd. A toothless smile here, a musical squeal there, and even hard-nosed cynics grow soft in the head and weak in the knees.
In the view of the primatologist Sarah Blaffer Hrdy, the extraordinary social skills of an infant are at the heart of what makes us human. Through its ability to solicit and secure the attentive care not just of its mother but of many others in its sensory purview, a baby promotes many of the behaviors and emotions that we prize in ourselves and that often distinguish us from other animals, including a willingness to share, to cooperate with strangers, to relax one’s guard, uncurl one’s lip and widen one’s pronoun circle beyond the stifling confines of me, myself and mine.
As Dr. Hrdy argues in her latest book, “Mothers and Others: The Evolutionary Origins of Mutual Understanding,” which will be published by Harvard University Press in April, human babies are so outrageously dependent on their elders for such a long time that humanity would never have made it without a break from the great ape model of child-rearing. Chimpanzee and gorilla mothers are capable of rearing their offspring pretty much through their own powers, but human mothers are not.
Human beings evolved as cooperative breeders, says Dr. Hrdy, a reproductive strategy in which mothers are assisted by as-if mothers, or “allomothers,” individuals of either sex who help care for and feed the young. Most biologists would concur that humans have evolved the need for shared child care, but Dr. Hrdy takes it a step further, arguing that our status as cooperative breeders, rather than our exceptionally complex brains, helps explain many aspects of our temperament. Our relative pacifism, for example, or the expectation that we can fly from New York to Los Angeles without fear of personal dismemberment. Chimpanzees are pretty smart, but were you to board an airplane filled with chimpanzees, you “would be lucky to disembark with all 10 fingers and toes still attached,” Dr. Hrdy writes.
Our capacity to cooperate in groups, to empathize with others and to wonder what others are thinking and feeling — all these traits, Dr. Hrdy argues, probably arose in response to the selective pressures of being in a cooperatively breeding social group, and the need to trust and rely on others and be deemed trustworthy and reliable in turn. Babies became adorable and keen to make connections with every passing adult gaze. Mothers became willing to play pass the baby. Dr. Hrdy points out that mother chimpanzees and gorillas jealously hold on to their infants for the first six months or more of life. Other females may express real interest in the newborn, but the mother does not let go: you never know when one of those females will turn infanticidal, or be unwilling or unable to defend the young ape against an infanticidal male.
By contrast, human mothers in virtually every culture studied allow others to hold their babies from birth onward, to a greater or lesser extent depending on tradition. Among the !Kung foragers of the Kalahari, babies are held by a father, grandmother, older sibling or some other allomother maybe 25 percent of the time. Among the Efe foragers of Central Africa, babies spend 60 percent of their daylight hours being toted around by somebody other than their mother. In 87 percent of foraging societies, mothers sometimes suckle each other’s children, another remarkable display of social trust.
Dr. Hrdy wrote her book in part to counter what she sees as the reigning dogma among evolutionary scholars that humans evolved their extreme sociality and cooperative behavior to better compete with other humans. “I’m not comfortable accepting this idea that the origins of hypersociality can be found in warfare, or that in-group amity arose in the interest of out-group enmity,” she said in a telephone interview. Sure, humans have been notably violent and militaristic for the last 12,000 or so years, she said, when hunter-gatherers started settling down and defending territories, and populations started getting seriously dense. But before then? There weren’t enough people around to wage wars. By the latest estimates, the average population size during the hundreds of thousands of years of human evolution that preceded the Neolithic Age may have been around 2,000 breeding adults. “What would humans have been fighting over?” Dr. Hrdy said. “They were too busy trying to keep themselves and their children alive.”
Dr. Hrdy also argues that our human ancestors became emotionally modern long before the human brain had reached its current average volume of 1,300 cubic centimeters, which is about three times the size of a chimpanzee brain — in other words, that we became the nicest apes before becoming the smartest. You don’t need a bulging brain to evolve cooperative breeding. Many species of birds breed cooperatively, as do lions, rats, meerkats, wolves and marmosets, among others. But to become a cooperatively breeding ape, and to persuade a bunch of smart, hot-tempered, suspicious, politically cunning primates to start sharing child care and provisionings, now that took a novel evolutionary development, the advent of this thing called trust.
To explain the rise of cooperative breeding among our forebears, Dr. Hrdy synthesizes an array of new research in anthropology, genetics, infant development, comparative biology. She notes that recent research has overturned the longstanding insistence that humans are a patrilocal species, that is, with women moving away from their birth families to join their husbands. Instead, it seems that young mothers in many traditional societies have their own mothers and other female relatives close at hand, and who better to trust with baby care than your mom or your aunt? New studies have also shown the importance of postmenopausal women to gathering roots and tubers, the sort of unsexy foods that are difficult to disinter and lack the succulent status of, say, a freshly killed oryx, but that just may help feed the kids in hard times. Other anthropologists have made the startling discovery that children have entertainment value, and that among traditional cultures without television or Internet access, a bobble-headed baby is the best show in town.
However cooperative breeding got started, its impact on human evolution was profound. With helpers in the nest, women could give birth to offspring with ever longer childhoods — the better to build big brains and stout immune systems — and, paradoxically, at ever shrinking intervals. The average time between births for a chimpanzee mother is about six years; for a human mother, it’s two or three years. As a result of our combined braininess and fecundity, humans have managed to colonize the planet; exploit, marginalize or exterminate all competing forms of life; build a vast military-industrial complex all under the auspices of Bernard Madoff and with one yeti of a carbon footprint, and will somebody please hand me that baby before it’s too late.

March 3, 2009
Short of Dentists, Maine Adds Teeth to Doctors’ Training
By KATIE ZEZIMA
FAIRFIELD, Me. — Cindy Merrithew was nervous about having her teeth pulled, mainly because a doctor would be doing the work.
“I was skeptical,” said Ms. Merrithew, 47, a nurse’s assistant whose mouth is filled with damaged, brittle teeth. “I didn’t know if they knew much about the dentistry field.”
Dentists are in such short supply in Maine that primary care doctors who do their medical residency in the state are learning to lance abscesses, pull teeth and perform other basic dental skills through a program that began in 2005.
“Doctors typically approach the mouth from a distance,” said Dr. William Alto, a physician at the Maine Dartmouth Family Practice Residency here in rural Fairfield, which conducts one of two dental clinics for medical residents (the other is at Maine General Hospital in Augusta).
“They say ‘say aah,’ take a look at the back of the throat and are done,” Dr. Alto said. “Many physicians, even family physicians, have given up that part of the body because they don’t have the skills.”
Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.
Nationally there is one dentist for every 1,600 people.
Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state’s largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state’s southernmost town.
Last year the American Dental Association and the American Academy of Pediatrics announced a program to train pediatricians to apply fluoride and look for signs of tooth decay, a step already taken by some other states, including Illinois, Iowa, North Carolina and Washington.
In Maine, training physicians in dentistry provides a dental safety net for the rural poor who have never had one, doctors and dentists said. About two-thirds of the residents who have trained at the dental clinic now practice in the state, many in rural areas.
“I see dental complaints all the time from people who come into the E.R.,” said Dr. Andrew Fletcher, who learned dentistry at Maine Dartmouth during his residency. He now works at Northern Maine Medical Center in Fort Kent, on the Canadian border. “It’s mostly Medicaid patients who don’t have money to see dentists.”
Maine Dartmouth’s office here is emblematic of the chasm between medicine and dentistry in the state: the office has 31 physicians in a county with only 12 dentists.
Ronald Smart, 51, who had not been to a dentist in five years, came to the Fairfield clinic on a Wednesday to have an infected tooth pulled; he has had three teeth pulled here before, and most likely will have more.
“It’s hard when you don’t have insurance,” Mr. Smart said. The severe decay of teeth like Mr. Smart’s can make simple dental procedures difficult.
Natalie Karishev, a third-year resident, pulled the tooth with Dr. Alto’s assistance. Dr. Karishev injected a painkiller in Mr. Smart’s gums and cheek, loosened the tooth and started to pull. Mr. Smart yelled; the painkiller was not working.
After injecting three more syringes of painkiller and applying a nerve block, Dr. Karishev was able to extract the tooth.
“It hurt, and I have a high tolerance for pain,” Mr. Smart said. “But once it numbed, it was fine.”
He has no issues with doctors pulling his teeth. “I don’t mind at all,” Mr. Smart said. “I think it’s great. It’s convenient.”
The doctors must also step in for dentists in urging patients to break bad habits — namely smoking and drinking soda.
Nicholas Noyes, 24, recently quit smoking and is trying to kick his two-liter-a-day soda habit.
“It’s so hard for me not to drink Mountain Dew every day,” said Mr. Noyes, who came to the Augusta clinic for tooth pain. He, like all the patients here, was referred to the dental clinic by his primary care doctor.
But after hearing Dr. James Schmidt, the co-founder of the dental training program, and the resident, Katje Musgrave, warn Mr. Noyes that he was in danger of losing all his teeth, Mr. Noyes decided to mend his ways.
“When they said I wouldn’t have teeth by the time I’m 34, that’s a biggie,” Mr. Noyes said.
Ms. Merrithew, unfortunately, is close to losing all her teeth. She needed three pulled on a recent afternoon. They were the first teeth Dr. Mark Winiecki had ever extracted.
Under the direction of Dr. Alto, Dr. Winiecki applied a topical anesthetic to Ms. Merrithew’s gums and palate, then started loosening a tooth.
“That’s good,” Dr. Alto said. “I like how you’re doing this. It’s going to save you work later.”
The doctors were only able to extract two of Ms. Merrithew’s teeth. The third kept shattering as Dr. Winiecki tried to loosen it, and they made an appointment for her with an oral surgeon.
After finishing the procedure, Dr. Winiecki was thrilled and relieved. “I’m excited,” he said. “It’s another tool in the doctor’s kit.”
While the Maine Dental Association supports the program, its executive director, Frances Miliano, said it would prefer to recruit more dentists to the state.
“Medical residents are only going to be doing this in really dire circumstances,” Ms. Miliano said. “They’re not going to be the alternatives to dentists in rural areas. It’s not a total solution by any means.”
Other places are trying similar approaches. The University of New Mexico School of Medicine runs a yearlong residency program for dentists, and medical residents are allowed to participate to learn basic dentistry.
“If that is a skill they would like to have in practicing medicine, we by all means want them to have that skill,” said Mark Moores, president of the New Mexico Dental Association.
Here in Maine, Dr. Alto and Dr. Schmidt, president of the Maine Dental Association, see the program continuing to train doctors, even as dentists move to the state. It helps both patients and doctors, they said.
“If you want to be a real doctor, you have to know how to do all the simple things in the field and refer out as appropriate,” Dr. Alto said. “We try to give experience not only looking in the mouth, but with all the things you can do.”