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Proof, at last, that chocolate is a wonder food! Yes, I know I’ve thousands of words debunking bad science and bogus ideas about health and bodies. (Offline, it’s upwards of a thousand pages.) But I’m also on record as supporting the health benefits of red wine and coffee (oh, and more on coffee here and here, for nervous new moms). And now, with chocolate, we’ve got the trifecta! A yummy, healthy hattrick!

From Moonstruck Chocolate in Champaign, Illinois, posted by Flicker user eszter, used under a Creative Commons license.

The bottom line is that a meta-study just published in the British Medical Journal found that the people who ate the most chocolate were  37% less likely to have cardiovascular disease and 29% less likely to suffer a stroke. No consistent, measurable impact was seen on diabetes or heart failure. Popular reporting on the new findings has actually been mighty thin, beyond the gleeful headlines. The New York Times and the medical newswire Ivanhoe both offered up the bare bones: the good news, plus a few cautionary phrases about the need for further research and a disclaimer that you shouldn’t just go hog out on chocolate because OH NOES, THE FATZ!

So I took a peek at the study, which is freely available on line. As all important research should be! I don’t care if we historians have to go through a library; the people who want to read my work know where to find me, anyway. But health is a public good, such research is often publicly underwritten, and most medical journals are part of a rapacious oligopoly raking in 40% profits on other people’s work. Earlier this week, the Guardian compared these journals to Rupert Murdoch, except with extra, surplus, bonus evil. Kudos to the BMJ for bucking this trend and letting regular folks view the full text without ponying up $35 or more for the privilege.

On to the study itself, which is a review of seven earlier studies that were mostly observational in character. None were randomized and controlled, so probably the whole lot would be discarded as rubbish by the Cochrane Review. They largely relied on questionnaires administered to patients, which raises the specter of recall bias. (I often can’t remember what I had for lunch yesterday.) As in any meta-study, comparison is difficult because the individual studies relied on different measures and methods. But they weren’t crap science, either (that was the point of excluding other studies that weren’t adequately rigorous or informative).

Importantly, most of the studies under review did make serious attempts to control for confounding variables (even though this reader was prepared to forgive just about any methodological flaw):

Five of the seven studies included in this meta-analysis reported a significant reduction in the risk of developing cardiometabolic disorders associated with higher levels of chocolate intake (one on cocoa intake), even after adjustment for potential confounders, including age, physical activity, body mass index, smoking status, dietary factors, education, and drug use. Although we did not find any experimental studies (randomised controlled trials) evaluating the effect of chocolate on hard cardiometabolic outcomes, our findings corroborate those of previous meta-analyses of experimental and observational studies in different populations related to risk factors for cardiometabolic disorders.

In other words, the literature is pretty consistent: chocolate is good for the heart and your whole cardiovascular system. And contrary to how some commenters at the Times were trying to spin it, those benefits were not negated by fat, whether in the chocolate or in the human consumer. They accrued even in people who ate the cheap, sugary stuff (though this is one area where I’d like to see research, which would no doubt confirm my own prejudice in favor of very dark chocolate). I am not surprised by this, since chocolate milk has already gotten the Dr. SunGold stamp of healthy hedonism.

Another way in which this strikes me as pretty good science: The authors point to a couple of plausible biological mechanisms that could make chocolate protective, which include “increasing the bioavailability of nitric oxide, which subsequently might lead to improvements in endothelial function, reductions in platelet function, and additional beneficial effects on blood pressure, insulin resistance, and blood lipids.” Nitric oxide, as you may recall, is the linchpin behind the effectiveness of a certain little blue pill. Viagra was initially under development as a cardiovascular drug that just happened to have felicitous effects on blood vessels located further south.

So in conclusion, if your chocolate bar is still rigid after 4 hours, you may want to consult your physician. Or you could just take it in hand and nibble it ’til it softens. Melting it into a hot fudge sauce is another medically advisable option. And remember: all that erotic enjoyment is good for you!

As for me, I’m trying to get a syllabus together this evening, so no cocoa-inspired sexytimes for me! But I just poured a glass of red wine and broke out oa square of the dark stuff. For breakfast, it’ll be my classic homemade mocha with Snowville milk. Now some intrepid researcher just needs to reveal the wonder nutrients in cheese.

From Chocolatier Blue in Lincoln, Nebraska, taken by Flickr user J. Paxon Reyes, used under a Creative Commons license.

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Oh, Ohio. The batshittery just never ends. As you may have heard, we’ve got pending legislation (House Bill 125, aka the Heartbeat Bill) that would make abortion illegal as soon as a heartbeat can be detected. That would be at six or seven weeks, when a woman might well not know she’s pregnant. (Keep in mind that spotting is fairly common during the first month of pregnancy when one’s period would usually be due, so even a woman tuned into her body could be fooled.)

This is the same bill for which Republican lawmakers called a fetus to testify. Actually, it was two fetuses, whose heartbeat was played for our esteemed legislators via ultrasound. (Quite sensibly, one of the fetuses refused to cooperate with the proceedings.)

Yesterday, the bill emerged from committee, but House Speaker William Batchelder won’t yet commit to a date for a vote. Batchelder is a Republican and a hardcore pro-lifer. Why would he waffle?

Turns out that this bill is splitting the anti-abortion camp. Ohio Right to Life – the biggest anti-abortion lobby in the state – is actually begging state legislators to back off of the Heartbeat Bill. They fear the bill couldn’t pass constitutional muster. Of course, this isn’t a principled objection. Ohio Right to Life remains committed to overturning Roe v. Wade. They just realize Anthony Kennedy is unlikely to vote to uphold a measure this extreme. (It doesn’t even include a rape/incest exception.)

I say, bring it on. Anything that divides the Republicans and anti-abortion lobbies is good by me. This direct challenge to Roe – which is what the Heartbeat Bill’s supporters actually crave – will go down in flames. If it passes the Senate and goes to the courts, the Supreme Court will surely refudiates it. This will strengthen Roe’s basic finding that the state cannot prohibit abortions prior to fetal viability. A successful court challenge might even take down Ohio’s 24-hour mandatory waiting period and “counseling” – or so fears Ohio Right to Life! My, this bill is sounding better all the time.

Here’s what really worries me. While we’re all distracted by chatter about vaginal sonograms in the Statehouse and the circus of fetuses “testifying,” another bill (H.B. 78/S.B. 72) has passed both chambers and is headed for the desk of Governor Kasich, who’s certain to sign it. That bill’s viability (so to speak) looks much stronger. It would ban abortion after 20 weeks (instead of Ohio’s current 22-week limit). In addition, H.B. 7 – which would place the burden of proof on abortion providers to show a fetus was not viable – is still lurking in the wings, along with other anti-choice legislation.

At least none of my representatives has threatened to criminalize miscarriages. Not yet.

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I continue to be transfixed by the situation in Japan, where technology has shown its best and worst face in the past few days. “Best,” I say, because the terrible human losses would have been greater yet, had builders not prepared for violent earthquakes. There were certainly gaps in planning for the tsunami, in particular, but overall Japan’s construction technology saved untold lives – tens of thousands.

The nuclear plants partly had bad luck, but then again, the chain of power failures that’s now leading to overheated radioactive fuel rods was fairly predictable. I don’t know enough about the technology to give an explainer. Rachel Maddow continues to have good coverage. But essentially, you don’t have to be a nuclear engineer to know that highly radioactive spent fuel presents a problem for decades at a minimum, even under controlled circumstances. How many civilizations have survived for tens of thousands of years – long enough to keep ploutonium contained? And yes, some of the fuel rods (about 6%) at the Daiichi plant contain some plutonium.

Then again, with some technologies you really don’t need to be an expert in order to say: this is stupid. A case in point is the use of hormones to stunt girls’ growth lest they grow too tall to catch a husband. I knew that this was a fairly common practice in the 1950s. A recent study reports that the estrogen used to stop growth also mucked with these girls’ fertility, and as adults they have had trouble conceiving. Not all that surprising. What did shock me? The fact that this practice continues today.

This use for estrogen gained popularity about 50 years ago after researchers found it might limit the growth of girls who were much taller than their peers in adolescence. According to one estimate, up to 5,000 girls in the U.S. were treated with estrogen, and many more in Europe.

At that time, “women were basically supposed to get married and have children, and that would be harder if you were a very tall woman, everybody believed,” Christine Cosgrove, co-author of Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height, told Reuters Health.

“There were so many parents, mostly mothers probably, who just feared that their daughters’ lives would be ruined if they ended up being six feet tall, because they’d never have a husband and a family,” she said.

Some tall girls are still treated with estrogen today — more in Europe than in the United States — and estrogen is currently given to these girls in about the same dose that is in a birth control pill, Cosgrove said. In the past, it might have been given at 100 times that dose before doctors realized the potential dangers, she said.

[Cosgrove is co-author of Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height, speaking here to Reuters.]

Two very different scenarios – one a matter of life-and-death, the other “merely” a matter of life foregone through infertility. Yet both reflect the foolhardiness of humans when it comes to technology. I’m no Luddite (my laptop is a cyborg extension of my brain), but could we just cut it out with the human experimentation? Because that’s what nuclear plants are, at bottom, too – an uncontrolled experiment with far too many uncontrollable variables. Also, perhaps friend-of-the-blog Hydraargyrum will chime in on this: humanity will never win against CORROSION, which is basically what I understand to be happening at lightning speed in those uncooled fuel rods.

Can’t we humans please learn for once, and put an end to the techno-hubris?

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Here’s an item from the annals of “no shit, Sherlock!” science: A UCSF study shows a stunning decrease in unintended pregnancy and abortion when women are dispensed a year’s supply of birth control pills at once. What’s stunning is not the basic trend line, but the magnitude of the study’s findings. Science Daily recaps it:

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one — or three-month supplies.

Can I rephrase those numbers? Pregnancy declined by nearly a third, and abortion by nearly half!

This is such an an simple yet elegant idea, you’d think it would have occurred to someone decades ago. It’s also a politically charged idea in an era where Planned Parenthood is having to fight for its very existence.

Insurance usually issues a maximum of a three-month supply of any medication, including birth control pills. This is true even for medication that people clearly have to take for the rest of their lives, such as thyroid pills. (I haven’t been on the Pill in years, but I still sometimes come close to running out of my thyroid meds.) The situation is often tougher if you have to buy the Pill through a community clinic:

The findings of this study have implications for women using oral contraceptives across the country. Most oral contraceptive users in the United States get fewer than four packs at a time; nearly half need to return every month for resupply, according to a 2010 study published in Contraception.

Obviously, the requirement to physically show up at a clinic is most likely to hit poor women – and it will be most onerous precisely for these women, whose low-wage employers are unlikely to grant them time off for medical matters. As is so often the case in reproductive health, this is a social justice issue. I really hope this study will get the attention it deserves.

I adore this quotation from the project’s principal investigator:

“Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, ” said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. “Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month.”

Of course, some Americans object to seatbelt laws – and even seatbelt use – as an infringement on their liberty. But I’m not talking about laws to require use of the Pill; I’m only saying that women should have access to it.

While we’re on the automotive analogy, isn’t the Pill more like a reliable set of brakes?

And wouldn’t the conservative attack on access be akin to sabotaging someone’s brakes?

 

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This week I’m reading Michelle Goldberg’s masterful The Means of Reproduction: Sex, Power, and the Future of the World with one of my classes. In it, Goldberg traces the history of foreign aid for women’s health – especially reproductive health – from its Cold War, Rockefeller/Ford/Guttmacher beginnings to the present era.

In 2011, well into the second decade after the UN International Conference on Population and Development in Cairo, you’d think we’d be well along the path blazed there: foregrounding women’s need for education and autonomy. Nuh-unh!! Instead, the proponents of women’s reproductive autonomy in developing nations and the Global South face constant friction and opposition from groups funded by the Radical Christian Right in the U.S. This trajectory toward radical rightwing interference is lucidly, chillingly described in Goldberg’s book. It’s as though women’s bodies became a proxy war for the tensions over reproductive rights and justice back here in the U.S.

And now, with the House of Representatives today voting to defund Title X funding, that proxy war has come home. For details, see excellent recaps by Lindsay Beyerstein and Jill Filipovic. The legislation wouldn’t affect abortions – except to inflate their numbers by making birth control less accessible to poor women and young women. No, the target here is broader. It’s a war against all women, but especially those who are poor.

When I was young and underinsured, I too turned to Planned Parenthood, and I’m forever grateful for their services. Some women are transiently poor, like I was. Many struggle with poverty throughout their childbearing years. All of us deserve affordable access to basic services like a Pap test.

I believe this even though – or especially because! – I had a few dodgy Pap test results in my early twenties. Those diagnoses of “cervical dysplasia” scared me. Cone biopsies were threatened. The cellular abnormalities resolved on their own, as HPV usually does. Had I progressed toward cervical cancer, Planned Parenthood might well have saved my life.

All women deserve preventive care, and that includes the prevention of pregnancy. This is sooo not rocket science.

Odds are good that the Senate won’t stand for the House’s crap. Still, I’m appalled that a majority in the House signed onto it. While some members may try to hide behind a figleaf of fiscal responsibility, that’s balderdash, as Amanda Marcotte argues:

Of course, rhetoric that attacks federal funding for contraception as a state-subsidy for promiscuity obscures the fact that continuing Title X is one of the more fiscally sound things the government can do: Research from the Guttmacher Institute demonstrates that every dollar spent on family planning saves the government four dollars down the road.

(Read her whole piece – it’s excellent.)

No, this is strictly culture war ammo, just as the Mexico City rule and all the other right-wing meddling into brown and black women’s bodies has to do with ideology and misogyny – not fiscal soundness.

This is merely the continuation of funding politics imposed on the “Third World” – now aimed at women that Chandra Mohanty once called the “Third World” in the United States. This is the redirection of contempt for brown and black women’s bodies to those women living within U.S. borders. Women like me – white, securely middle-class, employed, insured, and slouching toward the end of my reproductive years – will be just fine. It’s poor women of color who will suffer. College students who can’t tell their conservative parents that they’re on the pill. Appalachian women lacking any form of health insurance.

Senate? The ball’s in your court. Please show us that you consider women human beings whose health is as important as men’s – who should have a chance to participate fully in society – and who should not be written off if they lack racial or class privilege.

In the clip below, Michelle Goldberg suggests that the U.S. culture wars have affected women outside the U.S. more profoundly than women here at home. Up until now, she’s been right. As to the future? Well, that might just be up to the Senate.

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Here’s the backstory: Up to now about 20 percent of breast cancer patients – those found to have cancer in the lymph nodes under their armpits – had those nodes cut out as if they were little balloons that could carry metastases to anywhere in the body. And indeed, sometimes cancer spreads via the lymph nodes, which is why they had to go. Or so thought any responsible oncologist.

For the women who undergo extensive axillary dissection (that is, cutting under the arms and removing the nodes), the risk of complications goes up. They are more vulnerable to infection, but more importantly, many of them get lymphedema – painful, chronic swelling of the affected arm due to the inability of the lymphatic system to remove excess fluid from the limb. It’s miserable, disabling, and disfiguring. It can be progressive. It has no cure. You don’t want to have it. Women can also suffer nerve damage, shoulder pain, and limited mobility of the arm. (All of this goes for male breast cancer patients, too.)

But the medical thinking was: We need to cut out any microscopic cancers to minimize the risk of recurrence. What patient would risk her life to buck that logic?

Now, the sun has set on this thinking. A major new study has proven that for properly selected patients – those with tumors smaller than two inches whose cancer has spread to the nodes – axillary dissection and all of its attendant ills is not necessary. It confers no survival advantage. None! Chemo and radiation – which are de rigeur for anyone with nodal cancer – seem to work equally well if the nodes are left in peace. I have not looked at the study, but what I read in the New York Times was highly persuasive and well reported. (Were I the patient, I’d definitely want to scour the scientists’ original article.)

The new recommendation is irrelevant to most early-stage patients, whose disease has not yet spread to the nodes (which can be ascertained by examining a couple of likely suspects with “sentinel node biopsy”). Nor will it help those people diagnosed with more advanced disease. None of the patients in these two groups should be treated with axillary dissection anyway, under normal circumstances. But boy, it could make life after cancer a whole lot more comfortable for the folks who fall in that 20% – for whom lymphedema often became a painful lifelong reminder that they’d had cancer and it could recur at any time.

Will doctors actually take the study’s findings to heart? That’s where I’m skeptical. Axillary node dissection just met its Waterloo. But will breast surgeons – indoctrinated by education that says more treatment is better, and anything less is irresponsible – continue to fight the old battle? I’m afraid they will, and not just because I cynically think they fear lawsuits. (Any sentient doctor should fear lawsuits; they’re part of the landscape by now.) No, I worry that habit will prevail, along with the conviction that doing something is always better than doing nothing. The New York Times report that major cancer centers and a few individual doctors are changing their protocol:

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Patients may need to push their doctors. We can ask them about our options. If they’re unwilling to question from old methods, we can find another doctor. I’m not in that position right now (thank my stars), but I’ve had multiple scary mammograms. If I do get cancer, I’d hope for an aftermath where my body wouldn’t bear more scars than necessary.

The rage expressed in the NYT comments section by women who live with those reminders – unnecessarily, they now know – is justified, even though their physicians did the best they could with the knowledge they had. But now that we know more? I wouldn’t want to live with that pain and rage if it could be avoided. Life after cancer poses enough other challenges.

 

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Would you leave your gravely injured mate on earth while you blast off for several weeks in outer space? Today came reports that Gabrielle Giffords’ husband, astronaut Mark Kelly, may be planning to do just that in April. Salon describes Kelly’s choice – to fly, or to stay home and support his wife through rehab – as “a troubling predicament.”

Really? I’d say that if this is a predicament, my brain is a porous pickle. (Which, incidentally, is possible.) Your partner gets shot, through the brain, and a large arc of skull is removed to prevent brain cells from dying due to swelling. Minimum spousal duty according to Sungold: you stick around at least until the missing piece of skull has been replaced. This takes months. In the case of CBS newsman Bob Woodruff, doctors waited four months before reopening the wounds and placing a prosthesis. Until the patient has a complete skull again (whether composed of their own bone or, like Woodruff, a synthetic material), she wears a bulky helmet to protect the brain.

For me, staying home would be, um, a no-brainer. But can Kelly really help his wife? Salon reports:

Research shows a strong social support network — family, friends, church or similar — is crucial for rehabilitating patients and improves the outcome.

But that doesn’t mean a spouse has to be there 24-7, 365 days, said Dr. David Lacey, medical director of acute inpatient rehab services at Wake Forest University Baptist Medical Center in North Carolina.

“You also have to look at what’s normal for the couple,” Lacey said. “If it were my parents who had almost never been apart for the entire 50-some years they were married, all of a sudden changing that structure would be a pretty dramatic impact.”

But what’s normal for Kelly and Giffords, through their three-year marriage, is spending a few weeks apart at a time — he in Houston, she in Washington or her home state of Arizona. However, Kelly, 46, kept vigil at her side in the days immediately after the Jan. 8 shooting in Tucson. The rampage outside a supermarket left six dead and 13 injured.

But nothing is normal when one partner is struck by a devastating illness or injury. Three weeks of normal life is not the same as three crucial weeks in rehab. Indeed, nothing is normal now about their previously independent relationship. Giffords will rely on her husband as caregiver-partner for a long time to come. Perhaps forever. It’s hard to feel indomitable, I suspect, when your brain is protected by thin skin and a helmet. It’s hard to feel enterprising when your mobility is highly restricted.

I don’t know Congresswoman Giffords or her husband (obviously!), but I’m irked by the presumption that Giffords ought to be game for her husband taking off, because that’s the kind of gal she’s always been. She’s not that gal now. Salon, again:

Mark Kelly has said he’d like the decision to be made jointly, with his wife’s opinion, if possible.

A former NASA colleague, Susan Still Kilrain, said if she can, Giffords will tell him to go.

Kilrain, in 1997, became the second American woman to pilot a space shuttle. Then, she was single. She recalls how Ashby’s wife, Diana, urged him to continue with his mission training despite her cancer.

“She really wanted him to stop sitting around and waiting for her to die,” Kilrain said. “All the wives would feel that way, and his wife (Giffords) seems to have a very big support system.”

That said, there’s no way Kilrain would resume training under the Kelly-Giffords circumstances. Women, she noted, tend to be the caregivers. She points to her own life story: She stood down from space flying after her first child was born, and quit NASA in 2002. She’s a stay-at-home mom to four children, ages 4 to 11.

“Me personally? I wouldn’t fly,” Kilrain said from her home in Virginia. “But I certainly would definitely respect his decision to fly. I wouldn’t second-guess that in a minute.”

For me, this type of decision isn’t just Monday-morning quarterbacking. I’ve been on both sides of this decision (minus the cool space stuff). And guess what? I didn’t fly. Nor did he.

When my husband fell terribly ill in Berlin, we stayed on for months while he completed treatment. I didn’t think once of taking the kids and flying back to the States. I dropped out of teaching (without any pay) for six months. Good thing, too, because the treatment was about as perilous as the disease. He needed help, as much as I could provide while also keeping the kids together, body and soul. I needed to be near him. We needed each other. Believe me, you don’t want to be on the other side of the world – or even out of this world – if your partner is gravely ill. That bit about “in sickness and in health”? It’s a vow that expresses the (temporarily) healthy partner’s need, too, to provide care and support and closeness. It’s not just about the sick guy.

Then, turnabout: Two years ago, when an MRI report suggested I likely had MS or vasculitis in my brain, my husband was scheduled to attend a conference in Germany. He was worried about leaving me, and so he asked my doc what he would do. “I’d stay home,” said my doc. And so my mate canceled his trip. Fortunately, my brain managed not to explode. (We still don’t know what was up, but we’re pretty sure it’s neither MS nor vasculitis.) My husband could have made his trip safely, after all. He would have worried the whole time, and I would have quivered in fear, again responsible for the kids but without knowing if they could count on me. I was also just plain sick – very sick. I say he made the right call. He says he doesn’t regret it.

I question whether we should applaud wives for playing the martyr, struggling against long odds and terrible pain while their partner achieves a dream. We do not expect quite the same of men, nor should we. Instead, how about if Gabrielle Giffords and Mark Kelly make a mutual decision that isn’t swayed by these cheering squads who seem to hope Giffords will gamely wave him goodbye? (That image conjures up the anniversary of the Challenger, which just passed, and how those brave families on the ground sometimes don’t get their astronauts back.) Maybe they’ll decide that he should fly after all. But if he stays with his wife, I can’t imagine how he could ever regret it.

Really. It’s not a predicament. It’s a no-brainer. (That cheap witticism is sure gaining mileage, yes?) If you do what’s least likely to cause regrets, the prognosis for future happiness and harmony will be better. You don’t need a neurosurgeon, astronaut, or even a small-potatoes blogger in Ohio to say this. Most of us know it as soon as we reflect on who and what we truly love.

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