A (4:54)

Yeah, it's be extra vigilant if you're a step parent. You know, this is going to be tough. Raising kids is tough. And one of the ways that the toughness of raising kids gets ameliorated is by them being your genetic progeny. So you're like they're crying again for the seventh night in a row, but it's my cry. So. But if it's just the person that you're in love with, progeny's cry, there's a lot less motivation to be there and you might get more frustrated, so on and so forth. And yeah, I think it's a hundred x increase in child mortality when there's a one non biological parent in the household. So some of, some of the outcomes, I mean the base rate for that's quite, that's not saying that it's making a massive difference, but it's a sufficiently significant difference that it's something everyone should be aware of. You mentioned there about grandparents. What's the evolutionary role of grandparents? Why does it matter for raising kids back then and sort of what's the implication for today?

B (5:52)

Yeah, well, I mean, I think it's huge. Grandparents. Well, first, first of all, when we, we used to live about as long as the other apes, you know, up until about 6 million years ago, and the, the, the way we sort of extended our reproductive viability, most likely, especially for grandmothers, if if menopause was ancient as we think it was, it was by caring for children. So reproducing, indirectly taking care of the kids we've already reproduced and helping them. And one of the big ways we help them is by taking care of their children. And so there's been this long running history of grandparents and, and babies and children and grandchildren interacting and helping one, helping one another. And I think it's good for both, both sets. When I, when I was younger doing field work, I was interested in the, what the grandparents were doing and how they were helping and, and that sort of thing. And as I got older and became a grandparent, I was, I still was interested in the other stuff, but I became more interested in why we do it. Because it's hard work, you know, come home at the end of the day sometimes after there's been arguing and fighting. But you know, it really makes my life happier and more fulfilled. And I think we sort of have an epidemic of unhappy grandparents, at least in the US and I think in other parts of the world too. And you know, sitting on the beach, having your pina colada or golfing or whatever can, can be fine, but you get a lot more satisfaction over the long run. I think if you're useful, if you're helping people.

A (7:50)

Well, I remember David Buss saying, oh no, sorry, Steve Stewart Williams at the start of the Ape we understudy universe. He's talking about what is it that we are like maximizing machines or optimizing machines? I can't remember what it is that he says and he comes in to land at we are grandchildren maximizing machines or we are grandchildren optimizing machines? That it's not enough to just have a child, it's enough to have a child and make sure that your child has a child. And then we're kind of like, oh, okay, like my, my work here is done. But yeah, you know, to kind of put it in context for the modern world, one of the first things that everybody does is fly the nest. You're 18, you're off to university, you're 22, you get your first full time job, you move away to the big city and you don't really think about your parents in that sort of a way. You're liberated, you're, you're, you know, renegade, doing it on your own. And then even in the modern world, everybody has their own abode. Very few people are living in pan generational cities, let alone pan generational like houses or neighborhoods. And then even with all of those incentives all of the opportunity to travel the world, all of the different places and things that could distract you. How many people. When kids come onto the horizon and someone gets pregnant, moves back to the city where one of the parents are, Right, it is. So maybe not anywhere near as common as it would have been ancestrally, but to think you have all of this pull, all of these dynamics distracting you to go out, and there's still something in the back of your mind that goes, I think we should be near Nana and Granddad. I kind of get the sense that we should be back there. So maybe, I don't know, maybe evolution is still whispering in people's ears a little bit.

B (9:33)

It's a huge draw. I think it is. And, and then when, when they do it, they're, they're, they're very, you know, happy. I mean, it's just sort of a truism. If you talk to a grandmother or grandfather and ask them, you know, what's it like hanging out, having the opportunity to hang out with your kids, it's the best thing, best thing ever. You know, they. And again, you know, the nice thing about being a grandparent is you're not 247 either. You can sort of, you can do some of the other things like, you know, golf or hang out on the beach or whatever, but you have more flexibility. But, yeah, there's this draw. People, People just sort of naturally realize that, that, that's, that's the, the way to go. And that's why I, I'm concerned about some of our younger generation that, you know, they're, they're good people. A lot of, like the young eco warriors and so on, they, I read online, them saying things like, well, the last thing the world needs is more children. Well, you know, that you make that decision early and then it's hard to, hard to reverse that, you know, And I think, I think it comes back to bite a lot of them. But I also think kids are important. I think kids are going to be the problem solvers. You know, we have a lot of problems that the, the world faces, the planet faces and so on, and it's, it's not going to be your dog. I mean, I love dogs, don't get me wrong. But it's not going to be the dog who's going to figure out new ways to, you know, solve global warming problems or whatever. It's going to be, it's going to be our children. So. And the problem with it is, is you make that decision in your 30s and 40s and then you're 50 and you might start to say, oops, and then it's kind of late, you know. But one, one of the good things is that back. Natural selection never had to be more specific than it needed to be to solve the problem. So because we were embedded in these kinship networks and people, people like sex and when babies came, they tended to be pretty, you know, willing to care for them and love them and want to nurture them. That led naturally to reproductive success. But not very few of us just walked around back in the place of seeing, saying, I want to have children, I want to have children. Because we. Those other two things, you know, led to having children. And so I, I don't think early on as young people we, we think those things. So it's easy sort of to, you know, be led off track and, and say, yeah, I don't want to have kids. It's not a good thing to have kids for various reasons and whatever, and then suddenly think, oh, it's too late. Maybe I should have. Should have, you know, gone and gone in the other direction. So, so I worry about some of the younger generation doing that. But yeah. Oh. What I was starting to get at though is because natural selection is not all that specific, is you. You can probably make yourself happier and build a fulfilling life even after you've not had your own children and grandchildren just by helping. Because in, you know, help help, we, we feel good about helping. We feel good about being rele. Would encourage people out there to, even if they don't have children, to, you know, to maybe do something that's helpful for them. And I think they'll feel happier, happier for it. Maybe that's the pediatrician coming out in me.

A (13:30)

But okay, so one big mismatch pan generational allo parenting and then the sort of inclusion of, of grandparents. Is this, in your opinion, does this explain the grandmother hypothesis, why it is that humans exist after they're able to continue reproducing, specifically mothers or grandmothers?

B (13:57)

Yeah, I do. I think, I think there's reason to believe that menopause is pretty ancient, that it. That it started to happen right after the split from the other hominoid apes. So basically selection stayed stronger for longer because we were doing things helpful increasing our reproductive viability later in life. But selection, for some reason didn't push ovulatory function to later and later ages. And I think the reason is, is because it was more adaptive to stop at a certain age because children were becoming, you know, more, more helpless, more altricial. Is is the word. And their, their, their period of dependency lasted a lot longer. And so if you can, if you.

A (14:53)

As a woman can have a child at 71, the, the potential chance just to, just to kind of break that down. For people who might not be familiar with the grandmother hypothesis, can you give a basic bitch explanation of what it is, like why that's the case?

B (15:08)

Yeah, so women stop reproducing directly in their 40s because as children were becoming more and more needy and the chances of them surviving and being successful if you died before they were 10 years old or so became very, very, very low. And so it became adaptive to stop and nurture the last child that you had, maybe when you were 40 years old. And then, so we would, we would live that, that would keep natural selection stronger to later ages that, that need to reproduce indirectly by helping children you already had produced, that held off the ravages of old age. And so the whole thing just kept increasing so that eventually we live long enough to take care of our children's children. And so the grandmother hypothesis sort of explains why we live to later and later ages, but also why we don't directly keep reproducing during that time, I suppose, as well.

A (16:25)

Limited resources, food, not, not only care, but if you are able to contribute, if you're able to be a net positive to the survival of not only your children, but your children's children and maybe your friend's children's children, you know, and you get that reciprocally in, in return, the alloparenting thing. But you're not that much of a drain on resources. Older people don't eat that much, you know, they don't. I guess they need care kind of eventually at some point, but I would imagine that that care wouldn't have been very protracted. The end of life stuff, I imagine, isn't that sophisticated ancestrally, right?

B (17:09)

Exactly. Yeah. I was listening to one of your podcasts with Peter Attia, and he talks about slow death and long death. And, you know, the slow death wasn't. That wasn't there. You, you were relatively fit. And then, and then something got you, so you weren't a burden on everybody back, back in the day like that. And, and so even, even for males, you know, you, you brought up a good point. You know, you know, they might not be taking care of the children, rocking them to sleep and doing things like that quite as much as. As grandma did, but just, just the male being around held together, helped hold together kinship networks and help to transmit knowledge that had been accumulated you know, like where the, where the watering hole doesn't go dry when we're hunting for such and such and so on. Males, males could be contributors also. And if they weren't busy getting beat up by younger males because they were competing for, you know, the females, they, you know, sort of dropping out of that game and being helpful in other ways probably was adaptive for them too and a route to indirect reproduction.

A (18:21)

Okay, so grandparents pan generational raising, alloparenting, stuff like that, mixed age play, younger boys and girls learning from older boys and girls, roughhousing, understanding how status hierarchies work, getting to expedite learning because the older kids know more and they get to teach the younger kids as opposed to everybody kind of moving and discovering at the same age. What else, how else is modern parenting out of sync with how we revolve to raise children? What are some of the least aligned child rearing strategies of the modern world in your opinion?

B (18:56)

Well, I think that covers it in terms of sort of the sociology of it. But we're out of alignment with, in terms of infectious disease exposures and things like that with, you know, with our daycare centers and so on, stuff like that. Kids experience different degrees of illness, different types of germs, different immune system, developmental trajectories and so on. And again, kind of, I touched on this a few minutes ago, but just I think it predisposes sometimes to some of the, you know, not super severe mental illnesses which I think come more from you know, genetic and broken brain type way called break broken brain type phenomena, but just some of some alter, some of the altered inputs from not carrying our children around all day long and, or having alloparents carry them around talking to them all day. So those sort of early inputs are quite altered by the social structure that we now live in.

A (20:18)

Should we see teenage angst or anxiety or ADHD as adaptations instead of diseases then?

B (20:27)

Up to a point, especially anxiety. I mean you can't live without anxiety. If I could give kids a pill to make them never feel anxious, then that probably wouldn't be good for them. I mean we, you know, if you, if you're walking down a path in the woods and you see mama grizzly bear with her cubs and you don't feel a little bit anxious about taking the next step forward, that's probably not very adaptive. So, so we need to feel anxiety, but, but we need to learn how to deal with it because there, there are all kinds of anxiety producing situations that we have now that we didn't used to have, especially for teenagers. You know, they're, they're, they're, they're living in a virtual world a lot of the time and they're, you know, they're thrown into middle schools with, you know, 200 other kids their same age without support of, of kin all day long and, and that, and that sort of thing. And that, that creates anxiety situations that we, we don't need to eliminate per se. We need to learn to deal with them.

A (21:42)

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B (22:54)

Yeah, well, I, I think that it, it is, you know, having very supportive kin who, who love you all around that can sort of take you aside and say, all right, that's, that's not that awful of a situation and explain things to you, but I'm always struck by, and it's not always a bad thing, but I'm struck by the wide range of options that our teenagers face. Now when I was doing fieldwork on E, which is not a hunter gatherer society, it was a horticultural society, but it was pretty primitive. Pretty, pretty Isolated in the, in a technological sense. And those kids growing up knew what they were going to do. You were going to be, you were going to fish, you were going to build canoes, you were going to, you know, weave mats to build roofs for the house and you were going to take care of kids. And, you know, that that was about it. There weren't just this huge range of options. And, and again, I, I, I think it's great that we have this huge range of options. You know, you and I wouldn't be able to do what we do if we were living in that situation. But it also presents so much uncertainty to these kids. They sometimes just don't know where to go and then they re, they retreat into a virtual world and they don't know who to, you know, they don't have people around all day that they can talk to about it. They don't have older kids who have been through it necessarily to model after and so on. So it's pretty disruptive. ADHD is, I think it's a little different from anxiety. I think what I tell kids, and I may not be completely capturing the whole spectrum of it, but I tell kids, you know, that I was 5, 6 back in the day and I've since shrunk and if the whole world were a basketball court, I wouldn't be very well adapted to it. And now in school, when we send kids to school, we funnel them all through, you know, through the same funnel. And so we, we kids who are, you know, a little bit shy, quiet, they're not active learn active learners, they pay, they, they're good at paying attention, that kind of thing, they get overvalued. But the kid who's a more active learner, who would rather run around outside and learn things that way, they, they're not quite as able to. But back in the day, in the Pleistocene and on in existing traditional societies, there's room for kids to do, you know, if you're an active learner, well, you go out hunting. If you're an active learner, you make the arrowheads. You know, there's all kinds of roles for kids that they could fill.

A (25:48)

What are your thoughts on daca?

B (25:51)

On daycare? Yeah, well, I think, well run daycares can be good in the sense that they, they can mimic the alloparental situation where you have multiple committed individuals and you know, and, and especially if they're like, I think like in the Montessori settings, they'll have more of the, like, you know, three year olds with four year Olds with five year olds and so on. I think those can have certain advantages. But what I don't like about daycares is that, well first of all many of them are just overcrowded. You've got, you know, the caretakers are overwhelmed and they can't give the kids as much attention as they want. But it's the, it's the infection that there, I mean we live up north here in Michigan where it's cold six months out of the year and the viruses hit and you know, parents, you know, they have their kids in daycare and in three days out of five they've got to keep them home because they have a fever or something and all of that. So there, there's a lot of infection risk that you have to deal with that you wouldn't have had to deal with, you know, again during, during ancestral times.

A (27:12)

So it seems to me like one of the big changes is a level of attentiveness from primary caregivers to babies and then children. It seems to me like you're suggesting it would be rare that children would be put down on the ground sort of left, left all that much. Is, is that an accurate assessment?

B (27:32)

Oh it's abs. It's absolutely true. There was just no safe place to put a baby other than in a caretaker's arms, you know, during the Pleistocene and before that.

A (27:47)

Have you got any idea, just thinking on that. Is there any data around the difference in skin to skin contact time from ancestral times to the modern world? I think we know we're probably going to be talking what, 10%, maybe 20%.

B (28:02)

Yeah, I don't know of any data. It'd be an excellent study for somebody to do and maybe somebody has, if they have, I, I, I don't know but I think it's we down and things like, you know, plagiocephaly, the flattening of the head. Kid, kid. When kids are held you're always switching arm to arm, different positions and same thing when you know, with co sleeping, you know, doing it safely. Kids, kids, parents, parents would, you know, mom would sort of curl around baby, they'd be in different positions and so on. We can just see now that like six, I think one out of six kids in the US gets these head flattening conditions called plagiocephaly and it's from not being carried, it's from being flat.

A (28:51)

On your back, it's literally an imprint of the floor that you were laid on for so long when your cranium was still malleable.

B (28:59)

Exactly. And then the related condition is torticollis, where you get this neck tilt and then you gotta send them for physical therapy to try to straighten it out. So, so those are, you know, easily seen things, things you can notice. But I also wonder if, you know, we have all these sensory issues that come up in kids now, sensory integration disorders and so on, that tend to, you know, they can, if they're extreme, they can put them on the autism spectrum and so on. And I'm just wondering if, you know, you get different sounds, sights, smells, orientations and so on, that when you're being carried around and talked to constantly as opposed to stuck in a corner in some kind of little device or carrier, if that, if that doesn't impact the development of, you know, our sensory machinery up there in the brain.

A (29:58)

Well, think about all of the talk of attachment styles and attachment disorders. Anxious, attachment, avoidant, dismissive, I don't know. I mean, even the studies where baby is left in room, toys are strewn around, mum leaves room, mum comes back in, baby calms back down eventually. How far does baby go away from mum? I'd be fascinated to see the ancestral equivalent of that. You know, how, how amazing it would be for us to be able to run some of these split tests, experiments. So you mentioned that co sleeping, where would babies have slept ancestrally, how would they have slept? What's the typical sleeping environment? Give us a breakdown.

B (30:43)

Co sleeping was the rule. I mean, they didn't have soft beds and things like that. And heavy comforters mostly would have been done on mats or on firmer surfaces. And it would be generally mom would curl around the baby. The term that's thrown out there now is it's called breast sleeping. There have been videotapings of how moms just sort of instinctively curl around baby and then pat her on the head while they're not even awake. And baby has the breasts available and can go from side to side. So in my view, I mean, that's the way we always slept. There were no separate rooms or beds or anything like that. So it's not co sleeping that's dangerous, it's sleeping. Co sleeping dangerously, that's dangerous. You know, if you, if you're trying to do it on a couch or something where baby's head can get wedged in the pillows and that, you know, or the cushion, you know, that can be dangerous. But I think Japan is, is, is a good case in point. Co sleeping is generally the rule there. And, and they have half the SIDS deaths and half the infant Mortality rate that, that we do. So it's not co sleeping per se. I think it's co sleeping unsafely. That is the problem. And I think co sleeping has some advantages in terms of development. And it's, you know, this gets me in trouble with or at odds with the American Academy of Pediatrics. And I understand, I mean, they're speaking to a national population and they have to be talking to people who, you know, maybe they live in an impoverished situation where they don't have safe betting or maybe, maybe dad's an alcoholic and if he hops in bed, that does put baby at risk and, you know, all these things. So I sort of understand their position. But just coming out as they do. Hard stance against any co sleeping I disagree with, and a lot of the European countries are coming around to that view too, that it's okay to do it as long as you're being careful.

A (32:55)

Talk to me about the transport response in infants.

B (32:59)

The what?

A (32:59)

Transport response.

B (33:01)

I don't know what that is.

A (33:03)

When babies, they seem like they fall asleep more easily when they're being walked whilst carried. Is that not. Yeah, that was, that was. Rob Henderson and me were talking about it earlier on that if you want to put a baby to sleep, you put them in one of those, I guess, rocking, you know, it's like a automaton thing. And you're thinking, okay, so what are you trying to simulate there? You're trying to simulate being carried, right?

B (33:27)

Carried, exactly. Yeah. Yeah, I know. I, I just spent a week off with the grandchildren, one of them, six months. And I just kept saying to myself, why won't you let me sit down? You know, they, they just don't, they, they want, they want, they want you.

A (33:44)

Up, you know, and what's the adaptive explanation for that? Why would that be the case? Is that safer? If baby's being carried and moved, it's less likely to be eaten.

B (33:54)

I think probably it has something to do with that. I mean, certainly being carried and being in close proximity, I think babies feel anxious when naturally just feel anxious when they don't have that proximity. I'm not quite as sure about, you know, why, why they want us to be expending the maximum amount of calories carrying them about and rocking and bouncing. But you know what, what you just hypothesized there or speculated is that they, that's sending them signals that they're being held, that they're being cared for, you know, that, that it could be something.

A (34:31)

As straightforward as that they're a meal on wheels. As Opposed to a TV dinner. And it's harder to catch the meal on wheels, especially if the wheels are mom or dad. Yeah. Okay, so why, what about some explanations for why toddlers might wake up at night or throw food or act out? Why might those be smart behaviors in some way?

B (34:53)

Yeah, well, toddlers, toddlers wake up at night because they want to, they want to check in with, you know, mom and Dad, I think. And you know, they don't have as much incentive to, you know, they don't have to get up and do anything in the morning. And, and so they, they're, they're, they're free to, to satisfy their, their whims that, that way, as far as throwing food and tantrums if they don't get their way. Well, there are a couple things. Throwing food, especially vegetables and new foods. I, I think that toddlers, once, once you're mobile, you have this natural aversion to just putting anything, anything in your mouth. Unlike when you're, you know, four months old, you'll put anything in your mouth. But as you get more mobile, if you're, you know, just crawling about or toddling about the campsite, if you're willing to put everything in your mouth, that's probably not going to be good for you. So you hand a six month old a stock of broccoli, they'll eat it. You and a 2 year old a stock of broccoli, they're likely to throw it to the floor. And I think that makes some good adaptive sense as far as tantrums go and just being very, very needy. I think I don't really know what the adaptive explanation is for that, but I do, you know, think that they just cognitively, they're not very empathetic yet. They can't really put themselves in another individual's position and say, well, mom's busy right now. She can't carry me around even though I want to be carried around. And you know, and so they, they, they just want what they want. And you know, at one moment they might want to give you a kiss and the next moment they want to hit you over the head or something. Just because they, they, I, I don't think they've got it all, all figured out yet. You know, they, they're, they're still learning how to be social. I mean, they're, they're, they're much better at it than say a chimpanzee would be at a similar age. But it's a long learning process in humans. Learning, I mean, we're, we're the hyper social species, right? That's, that's how we've prevailed is we, we know how to get along in groups and we reciprocate with one another and, and it's a long lesson for kids to learn. Sharing, you know it's, it's not an easy concept but they, it takes a long time to learn it and that's why a lot of allo parents a lot of help and taking a long time to do it is, is very important. That's why those things have evolved. I think.

A (37:48)

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B (39:10)

We know it's the the best way to go and we it has numerous advantages for baby and and mother. You know, it helps establish a proper microbiome. It helps protect you early on in life when your own immune system is still getting up and running. Protects you especially from diarrhea illnesses which used to kill a lot of babies back in, you know, in traditional societies. There's some evidence I don't know how solid it is. But there's some papers that I've read suggesting you get 4 to 5 extra IQ points if you're breastfed for a long period of time versus just imbibing in formula. There's some evidence that the microbiome interaction with the immune system and the nervous system can help reduce risks of developing mental angst problems, depression and so on later, later in life. And then of course, for mom, moms reduce their risk of, of breast cancer from breastfeeding.

A (40:23)

No way.

B (40:24)

Yeah. Yeah.

A (40:25)

Wow.

B (40:26)

Yeah. And there's a really cool study. I, I, it seems to be pretty empirically sound. It was very surprising to me. It's in evolutionary medicine and public health from a couple years ago, showing that moms who breastfeed their babies have a lower incidence of developing early dementia.

A (40:48)

Oh my God. How much is that selection?

B (40:50)

Maybe some correlate.

A (40:51)

I was going to say it could be a selection effect.

B (40:53)

Yeah, right. Yeah. So I don't know. But yeah, multiple, multiple benefits from it. And unfortunately, you know, we don't grow up with it. We, it, it's very smart. I have some very smart parents in my practice and you know, they're, they're surprised when I tell them babies are designed to breastfeed for a couple of years and they don't know about breastfeeding. And they come in from the hospital, even if they've talked to a lactation consultant with their spreadsheets and so on. Baby's done this baby's had so many poops and so many voids and blah, blah, blah, and they're all uptight and milk's not coming in yet and they're start. Somebody's telling them they have to supplement and it all just interferes with breastfeeding. You have to relax. It just happens. You just, it, you know, there's, there's no breastfeeding failure in traditional societies or it's a very, very rare because everybody sees it happen, they know how to do it and, but we have, I think it's less than 50% of US babies are still breastfeeding at 6 months. And a lot of them don't even get that far into it because they worry about, you know, the initial weight loss or they worry about the jaundice that develops when you're getting a little bit dehydrated and, you know, breast milk's not there yet and it's not washing out bilirubin and so on, and, and they start introducing formula and then baby says, oh well, this is easier and learn to prefer the bottle over, over the breast. And so, you know, more often than you might think, both baby and mom end up giving.

A (42:43)

Oh wow. Both parties have been weaned off of breastfeeding.

B (42:49)

Yeah. Right.

A (42:49)

So, yeah, that's interesting. What about C sections?

B (42:55)

Yeah, I mean, I think, you know, C sections obviously can be life saving and are necessary in, in some circumstances, but they, I, I just think that there some, in some birthing centers, there's, they're just a little bit too cavalier about it. You know, mom's got a, something coming up or the doctor's got a vacation. You know, it's just, yeah. You know, you're at 40 weeks now. Let's not let it go too long, let's just do a C section, that kind of thing and, or let's induce same sort of thing. So mom and baby have evolved a really good communication system for when baby is supposed to come. And we're not always really good at estimating what the exact conception date is. We know that because, you know, some babies are, are, are conceived now through artificial insemination and, and we know then when they are conceived and we know that we're a little bit off when we're estimating using ultrasounds and when mom thinks her last period was and so on. So, so I, I think they're overdone basically, is the short, short answer. They're, they're life saving, wonderful interventions if done appropriately and much more sparingly than they are done now. Same with inductions. I, I just don't love to hear, ah, you're, you're 41 weeks and everything looks good. But maybe we should just induce you right now. Well, well, if everything looks good, I, I always want to wait a few more days, you know. So have you got a, have you.

A (44:36)

Got a perspective on epidurals? Is there any insight there?

B (44:42)

I'm not a real expert in that, but what I, what I've been told by my moms and people that have them is it can interfere a little bit with pushing and getting, getting the baby out. And so then that increase your risk of some doctor saying we better, we better do a C section here, that, that kind of thing.

A (45:04)

Is there such a thing as a part epid? Can you reduce down sensitivity by 50% or something like that? Do you know if they can tolerate it?

B (45:12)

You know, that's a good question. I, I don't, I don't know the answer to that. You would think that would be a good, a good idea. I mean, it's easy for me to say, you know, you know, don't do epidurals. But I mean my, my daughter and daughter in law were able to do it and yeah, I guess they're pretty tough, but probably no tougher than the average.

A (45:32)

So do C sections interrupt lactation?

B (45:37)

I think so because again, there's this fine tuned timing mechanism between when baby should come and when nursing should start. But also mom's sore. I mean it's a surgery and mom doesn't feel quite as good. And it's just harder for mom to get things going and be quite as committed and diligent to it when you're recovering from a surgery. I mean, I could see, you know, that if I, if I had to do some type of childcare thing, obviously not breastfeeding, but I had just had a hernia surgery or something, I might be less reluctant to carry out my duties in that situation. So I think it probably does interfere some.

A (46:24)

I imagine that you have some concerns about surrogacy in that case then.

B (46:28)

Yeah, yeah, that I, I haven't experienced too many people who've done it and I haven't run into any problems. But yeah, there, there certainly can, can be, you know, it's a sort of a mismatched kind of thing. It's a not very novel sort of thing. So we would expect there could be some problems there that crop up.

A (46:53)

Childbirth, child rearing in the modern world certainly seems to have become very medicalized. I wonder whether this over medicalization could contribute to fertility decline in some way.

B (47:09)

Yeah, I think so. Like I said, people come in with their spreadsheets and I have to tell them forget about counting the number of dirty diapers and all of those things. And people, you know, they, they come in with, yeah, they've had C sections, they've had, they, yeah, it's been over medicalized and, and it's, it's, it's just a much more stressful kind of thing than it is most likely in, in a more natural setting. I think midwives often get people to relax. There's also a, you know, a home birth trend which, you know, I mean I, I see the reasons for it and when it works, it works, but it's also more risky, you know, if something, because things do go wrong in modern medicine, you know, like, like again, like your previous podcast with Peter ati, we're good at fast, fast deaths. We're good at avoiding those. If something goes wrong, you want to be there, you want an obstetrician there who has a scalpel on hand. If you need it. Yeah. So anyway. Yeah.

A (48:28)

What have you come to believe about the current demographic transition, these declining birth rates that we're seeing?

B (48:35)

Yeah, well, that's sort of what my early interest was as a graduate student. When I went off, I went to Penn State and worked with an anthropologist named Napoleon Chagnon. And he was in very much into evolution. He was a cultural anthropologist who was becoming an evolutionary anthropologist. Then I followed him in Northwestern my second year and I had to figure out something to do. So I would go into the library and I got interested in demographic transition. And there was not a really good explanation in my mind for why people in modern settings had decided all of a sudden, you know, they'd switch from we want to have as many babies as we can to we want to have just a couple or in some cases none. And the prevailing ideas out there, the prevailing theory was coming from economists and economic minded demographers and their thought was, well, in traditional settings, after you pay this little upfront cost, kids become assets. They make you, they make you wealthy basically. And especially they care, take care of you and things like that. And so there's no reason to limit reproduction in traditional settings. But because they lived in modern settings and they probably had kids, they knew kids were expensive in, in modern, modern settings. And so they were arguing that we would limit the consumption of children, expensive goods. Just likely we would limit the consumption of all other expensive goods. But that didn't make sense to me from an evolutionary point of view. First, I didn't trust their data because they would go into these traditional societies and ask hunter gatherers, why do you want to have so many children? That would be like asking, you know, why do you, why do you breathe? And so I think I thought they probably teased out the answer they wanted, but, you know, I have no way of knowing that. So. But what really troubled me was it didn't make sense from an evolutionary point of view that we had kids in order to eventually economically exploit them. Again, going back to this idea that we had lifespans, maximum lifespans as long as the other apes, and then they gradually increased and doubled because we were doing things useful for our children. That, that sort of idea didn't jibe with the idea that, you know, once, once they became 20 or 30 and we were 50 or 60, that, you know, we were just going to kick back and let them take care of us. I always felt it was going to be the other way around. And that's my early work contributed to the grandmother hypothesis. And as it contributed to what we now consider to be the right explanation for why lifespans doubled. But this notion that wealth flows switched as modernization occurred and that's what made us not want children didn't make full sense to me. Now it does make sense that children, of course, became more expensive as, as we left traditional settings and stuff, but they were always expensive. They were, they, they, they never really did. Gave us more than we gave them, except in terms of life satisfaction, maybe. But so that, that my explanation is, is just that, that we don't have kinship networks anymore that help spread out the costs of rearing children. Costs get concentrated on mom and dad. Mom and dad say, you know, this is hard work. We love these kids, but we're only going to have one and we're only going to have two. And some people look around and say, oh my friends over there are struggling. I'm not having any. So I, I think, I think it has a lot to do with the demise of extended kinship networks and that help in the concentration of, of care responsibilities on the, on the decision makers.

A (52:46)

My, I, I've spent a lot of time thinking about this, much to the Internet's distaste, But one thing that I don't think gets talked about sufficiently is the sort of mimetic desire to have children to that, oh, wow, my next door neighbor, they just had kids and, or my sister just had her first boy and she seems really happy. And that's a good. Maybe, maybe I should think about the, you know, fewer children beget fewer children, beget fewer people, seeing children, et cetera, et cetera. And yeah, it's the vicious other side of the blade of being a hypersocial species, as you said, ultrasocial species. So moving on to. We've talked a lot about sort of development, child rearing, the more sort of psychological and social side of stuff. If we get into the more medical elements of the pediatrics, what are some examples of medical missteps that could have been avoided if we'd had some evolutionary thinking?

B (53:49)

Well, the, the big one that, that I worked on has to do with food allergies, childhood food allergies back in the 90s and it was officially codified by the American pediatric society in 2000 or 2001, I think it was that you delay, delay, delay when it comes to the introduction of the eight or nine most allergenic foods. And I mean, first of all, that evolution aside, that just never made sense from an immunological point of view. It just, I don't know how they came up with that Idea. Because once the immune system is able to cause destruction, which starts in utero and is present in a big way even shortly after birth, you have to have proper tolerance mechanisms. It's not like you can wait till you're three years old to learn not to attack your own liver. So why they thought waiting till you're three years old to introduce peanuts, you know, is really, really beyond me. But the, the evolutionary angle there that if they had been more attuned to how we lived, you know, in, during the Pleistocene and before that, we were immobile pretty much as a species. We didn't, you know, we, we grew up in and died in the same ecosystem, basically, generation after generation. So what that meant was that while, while mom was, while you were inside mom and she was eating, you were getting exposed to food antigens. When you were, she was breastfeeding you, you were getting exposed to food antigens. When you first started eating foods yourself, you were getting exposed to food antigens. And those food antigens were the very same ones that you were going to get exposed to for the rest of your life. And so they eventually learned, not through thinking about it theoretically in any way, but just by going, oh my goodness, food allergies are soaring. And oh, look, they're not allergic to peanuts in Israel because they, they feed children early on. They call them bombas, which are peanut butter containing biscuits. And so people started looking, well, maybe, maybe we made a mistake here, maybe we should introduce things early. And so they eventually did some studies and found out that that was true. But, but if you thought about the way people always ate, you would be introduced to all the foods you would ever eat, all the, all the allergens, all the antigens that you would ever encounter early on in your immune system would learn to tolerate them. And so it never made sense to say, let's not, let's not introduce things until you're older. So I think evolution mindedness could have helped us to avoid that problem, you know, but I mean, I think there are others. I think evolution mindedness can help us to understand what's a healthy diet. It can contribute to that. I mean, I know from listening to you you're interested in that. It turns out there's a really cool study that was done with fruit flies by Michael Rose and his group. Grant Rutledge was a grad student or a fellow who worked with him. And what, what that, what they did was they, they, they changed up the diet that the fruit flies had evolved to eat. They, they had been eating for thousands of generations, they had been eating apple rotations, and then they brought them from that area, which I think was on the east coast, to Michael Rose's lab in UC Irvine. And they didn't have rotten apples, I guess. So they fed them bananas doused in high fructose corn syrup. And what they found was that after about 40 generations, flies had adapted to that new diet to accommodate it really well while they were young. But even after a hundred generations, they hadn't adapted to accommodate that new diet. They were old. And that the, the most parsimonious explanation for that is that, number one, selection is most powerful early in life, and number two, most genes have their effects combined confined to certain ages. So that if a mutation comes along that allows a young fly to better digest a banana, or if a mutation comes along that allows an old fly to better digest the banana, potent selection would accumulate for the young fly, weak selection would not accumulate for the old fly.

A (59:04)

Is this why kids tolerate modern diets better than grandparents do?

B (59:08)

Exactly, exactly. That's right. So beyond a certain age, you know, maybe 50 or so, maybe earlier, you should lay off the pancakes and donuts like that. I mean, no, nobody should be eating too much of that stuff, but you can, certainly kids can do it, they can tolerate it much. They can tolerate a grain heavy diet much better than, say, somebody my age.

A (59:34)

That's so interesting because of that.

B (59:36)

Yeah, yeah, you can apply that also, that line of reasoning to infectious disease. And I, I did that in an article shortly after the pandemic got going, Crowd diseases, you know, came on board. Once we started settling down and living in crowds, moving indoors and so on, things like, you know, influenza and tuberculosis and all those sorts of illnesses. And so as long as those diseases had certain commonalities, like they relied on crowding and, you know, maybe aerosol breathing in aerosolized virus, that kind of thing, Young immune system should evolve more quickly to be able to adapt to those crowd diseases than old immune systems would. And there's an evolutionary biologist that I've talked to who works with fruit flies who's interested in maybe trying to test that idea. But it's a little more complicated with immunology than it is or with infection than it is with diet, because we have a very potent adaptation immunologically that helps us when, when we get a little bit older to, to fight diseases. And that's immune system memory. So very, very young children often don't do as well within. Oh, of course, because they have an acquired memory.

A (61:10)

You've accumulated all of the different blueprints of all of the different pathogens.

B (61:15)

Exactly. But when you're talking about a brand new virus that's just jumped into the population, no one has any memory doesn't count anymore. And then you should expect the young to have again, there have to be commonalities, and there are four other coronaviruses out there that pass through over the last 10,000 years. You would expect young people to have evolved adaptations to deal with those infections to a better extent than old people. Just as you would expect it for diet.

A (61:52)

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B (62:58)

Yeah, I mean obviously it's just a terrible problem in our society. Yeah. And like you said, it can start early. And I mean it I think largely comes from a mismatch. We used to have to work harder for our foods and exert ourselves and calorie dense foods were not as available so we developed a taste for those. And now that we don't have to work hard to get the calories and we still have the taste for them, many people overdo it and they get their kids on that wagon quickly too where they're over consuming and, and then there's also just foods that nobody's had time to adapt to. This stuff in the center aisle of the grocery store, you know, the, the trans fat laden things and all that that people soda pops and those kinds of things. That people bring, bring into their house. And so it's a, it's a daunting problem though. You can explain it to people, it's easy to get, it's easy to understand that, that mismatch. But getting people to, you know, be more active and avoid some of the, some of those foods is just a hard thing. I, I, you know, I dread it when I've got a 10 year old who can't hop up onto the exam table. He already weighs 130 pounds and you know, his parent sits down on the bench in the room and you know they're, they weigh 300 pounds. I mean what can I do? You know, I, I, I, if I could take the kid home with me, you know, maybe I'd have a chance. But it's just, it's a really, really hard problem to solve. But I think it's just so, so such an important thing. I mean especially are, I mean it's a problem in kids but it's especially a problem in, you know, as people get older and you know, I, I don't know what the number is but so many of our healthcare dollars get spent keep keeping people who've abused themselves, you know, for five, six decades alive or you know, trying to keep them partially alive at least. And I mean I think most of our health care dollars get spent trying to keep somebody alive for the last three months of their life, lives and that kind of thing.

A (65:37)

Is that right?

B (65:38)

I think so. And if, if it's not that I'm against helping people when they're older, but if, if people would help themselves when they were younger and avoid some of these problems, all those healthcare dollars could be shifted to young people and you know, daycares could be better and then the mom stuck at home with three kids and no help. I mean we could reallocate a lot of these things as a society if people were just more responsible. But it's a tough problem, isn't it?

A (66:13)

I mean, yeah, it's not just responsibility. Right. It's hyper normal stimuli, calorie dense foods. We're not adapting for the salty sweetie.

B (66:21)

Absolutely.

A (66:21)

Fluffy, crunchy, you know, all of the design.

B (66:25)

Uh, yeah, it's, yep, we're up against all, all of that and trying to get people to change.

A (66:31)

When it comes to medication, do you think are we maybe overusing medication in some ways for issues that might be biologically meaningful? Are we stepping into important processes that wouldn't have obviously been intervened with ancestrally?

B (66:45)

I mean, I think so. You know, I think antibiotics are wonderful inventions and life saving, but they're certainly overused. And so that leads to the evolution of resistance and stuff. But the big category that I think is overused are the psychotropic medications, the, you know, putting. Putting teenagers on multiple antidepressants and ADHD medicines and so on. I always happier to start with, you know, changing behaviors, modifying behaviors. Start with some counseling, start with some explanation, explaining to kids that it's natural and okay to feel anxious. Have you heard about the smoke detector principle?

A (67:36)

Of course. Yeah. That it's better to think there's a fire and then not be one than it is for there to be a fire and you not go off.

B (67:43)

Right, right. So anxiety sort of operates that way. We get anxious, and there's just so many things out there now to get anxious over. We have to learn to deal with it rather than take a pill to try to eliminate it. So I think there's a lot of overuse. And of course, the SSRIs that are used so commonly don't probably work as well as sustained exercise does over the long run. And, you know, but it's, it, it's. It's a lot easier to take a pill, you know, and people, people often choose the easier way. And there's a lot of pressure, you know, from the television and other media telling you take this antidepressant, and if that doesn't work, maybe another one will make you happier. So I think, yeah, I think it's overused. And I think having an evolutionary perspective can, you know, which includes something like the smoke detector principle, can help us to sort of pull back on some of those things. And of course, these old people we talked about who are unhappy because they aren't taking care of their grandkids and they're on their SSRIs, well, move closer to your grandkids. I think that'll work better.

A (68:57)

I would love someone to do a study, you know, pay for older people to move closer to their grandkids and give the other group SSRIs and see which one's happier. Yeah. It's really interesting, I think, considering.

B (69:15)

How.

A (69:16)

Modern interventions that are well meaning and, and, and help and, and are needed in many contexts. I think a lot of the time it's the over prescription in the same way as it's not bad that we have cheesecake. I'm really, really grateful for the inventor of cheesecake and for the Earl of Sandwich and his invention of the sandwich. But it's the over application of, of these technologies and these foods that Cause the issue, what would, I'm interested. What would an NICU look like if it respected evolutionary design, do you think?

B (69:54)

Well, you would, you would allow parents, mothers to be in contact with their, with their babies more and there, there's, there's, they're doing that to some extent. You would be, you know, you would be introducing breast milk as early, early as you can. You would be. I mean I saw, I don't know how common it is, but when I was a resident and in, in the nicu, you know, I saw babies who were induced or made to come early who then had breathing difficulties and ended up in the ICU and on ECMO of all things because of, you know, kind of stupid errors like that. And so I, I think just, just trying to being less cavalier about in inductions and C sections would, would help change the, the complexion of, of, of NICUs, but just allowing more parental contact, you know, they, they, they have and I think there's movement towards that. There's good information that they're trying to. The problem is it comes slower than I would expect because they have to wait for a study to show it over and over again before they'll intervene in a way that makes sense if it's dangerous intervention. But if it's an intervention like let mom hold her baby more, it doesn't seem like it's that dangerous to me. We might not have to. And it might make sense from an evolutionary perspective. We might not have to wait for six multi center studies to be done in order to conclude that that's a good idea. So again, when it's a dangerous intervent, potentially dangerous intervention, you want to have all those multi center studies done. But doctors, in my opinion, you know, for good reasons, are a little bit leery of theory. Nobody wants their doctor that's dreaming up a treatment for him in the shower the morning before. That's just, you know, kind of a wild speculation. Evidence is a good thing, but it can be, it can be overdone too. Doctors just, you know, medical students, they're just, they're just not taught theory the same way graduate students are in other, other scientific disciplines. And of course I'm partial to evolutionary theory and I really wish that, you know, it made its way into the licensing exams and it made it into the pre med programs and all that. I was thinking about when I got into medical school. I had already had a PhD and I was teaching at University of Michigan and they let me in, which was great, but they said I had to go take an organic Chemistry course. So I went to the local community college and took that. And I've never really had to know any organic chemistry in anything I've ever done as a pediatrician. But if rather than that, or at least in addition to that, I'd love to see pre medicine programs include evolutionary biology courses and I'd love to see continuing medical education include more evolutionary biology. And I'd really love to see more evolutionary biology undergraduates decide to go to medical school. That would be, that would be a real boon to the discipline.

A (73:38)

I'm all for it. I'm super all for it. I think all parents need to read, in fact, all single people need to read a behavioral genetics book as well. If you're intending on having kids at some point. I think all of the dating advice in the world and all of the child rearing books in the world could be replaced with blueprint by Robert Ploman maybe. Look, if you want to have a family at some point, it is made up of the raw materials of the person that you make them with. And it's the single most important decision in a child's happiness. You, you can't out educate bad genetics. Bad, you know what I mean? Like difficult genetics, suboptimal in your choice. So you mentioned that evolutionary theory. You're a fan. I'm a fan. What are the risks and are there risks in misapplying evolutionary theory to social or medical contexts?

B (74:37)

Yeah, if it's badly applied. I mean there's this whole. Been a ways back now of, you know, of social Darwinism and so on where, so people can misunderstand and think that it's all about calling the weak and sick from the population and doing things. I did an interview years ago for one of the science magazines where the interviewer, real nice woman, wanted me to make clear that as a Darwinian pediatrician, I was in favor of taking care of the weak and the sick also, you know, because she, she thought Darwinism implied that, you know, some people might think that that's not the case. So I mean, I think done. Done poorly, social Darwinism can, can creep in. Evolutionary biologists, if you hang around in those circles, you'll often hear them say evolution is, or the theory is descriptive, not prescriptive. And, and it is, it's, it's up to you. But in a little sense, in evolutionary medicine, we, we kind of violate that in the sense that we'll say things like we, you know, we, we might prescribe letting that fever go because fever is an evolved adaptation that helps you to fight your illness. So, so we're being, I mean, we're not forcing anybody's hand, but we're giving advice that says avoid the trans fats, let the fever go, let the, you know, those kinds of things. So we're being a little bit prescriptive, I guess.

A (76:13)

I, I have a friend who is very forward thinking around his health, early 30s guy, and he, he actively seeks out illnesses that cause fever. And this is because of some evidence that he's looked at that suggests that getting a fever and raising your body temperature internally is good at, is protective against cancer growth because it, it burns that through. Whereas, you know, immediately you have a, you have a fever and what are you doing? I, I'll regulate with air conditioning. I'll take something to bring down the temperature, I'll go in and see the doctor, so on and so forth. And yeah, it's, it's funny the problems that are caused by being able to fix problems, you know.

B (77:04)

Right, right. No, you're right. Yep. And, and without recognizing that some of them are defenses, if it's normatively bad, feeling sick with a fever is normatively bad. And so doctors exist to fix things and make you feel better. And so we prescribe, we tell you to take, you know, the old saying, not in pediatrics, but the old saying for adults was take two aspirin and call me in the morning. Right. And we don't give aspirin to kids. But the idea is the same. We, we, we, you know, we often tell them, take, take your ibuprofen or your acetaminophen, you'll feel better. And there are roles for those things. It's not like you can never use them, but it's, yeah, like you said, fixing things often makes things worse.

A (77:56)

Paul Turk, ladies and gentlemen. Paul, you're awesome. I think an evolutionary perspective on child rearing was desperately needed. And I'm really glad that Rob introduced me to your work. I think it's so great. Where should people go? They're gonna wanna keep up to date with the stuff that you do and get ahold of the book.

B (78:14)

Yeah, I mean, the book's available on Amazon. It's called Bringing up an Evolutionary View of Pediatrics. They can go to my website. Anybody who wants to ask me a question about their child, they can, they can call my office.

A (78:34)

How amazing.

B (78:36)

I, I, I, I'm always interested to talk to people about evolution and child rearing. Uh, I've had, I, I, I'm fortunate to have so many wonderful parents in my practice who sometimes I feel like I might be boring them with some explanation. But then, then they come back to me and they say, wow, that's really cool. And I ran into a woman in the grocery store the other day who read my book and she says, I didn't know you were so funny. I try to put a few jokes in there, you know, to keep people's interests and so on. So. Well, so, yeah, so it's been exciting for me to write the book and have people like you and Rob notice it. And I'm very grateful for being able to talk to you. I've been watching your podcast. My son has been a big fan for a long time. Yep. Yep. And he's. Yep.

A (79:33)

Well, I promise you that you haven't bored anyone today, Paul. And if you're, if your son is a fan of the show, that suggests even more about the quality of the genetics. I'm sorry. I'm very good. I really appreciate you, Paul. Until next time.

B (79:46)

Okay. Yeah. Well, thank you. Yeah. Okay. Take care.

A (79:51)

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