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Archive for the ‘medicine’ Category

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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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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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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I’ve been reading a lot more than writing the past few days. One of the themes that has popped up repeatedly in the discussion of the Arizona shootings is whether college officials should have been far more proactive in seeking help for Jared Lee Loughner. The New York Times today ran no less than three pieces on this topic:

Couldn’t a caring teacher have intervened? It’s an appealing what-if, isn’t it?

Take for instance the piece that appeared yesterday in Salon, where Sarah Hepola interviews a psychiatrist, Dr. E. Fuller Torrey, on the probability that Loughner has untreated paranoid schizophrenia:

Hepola: … What do you do when you see someone like this?

That’s the $64 million question. Among his classmates, if you took all the information known about him and looked at it together, you’d say this guy is potentially dangerous. But one classmate saw one thing, another classmate saw another. The college apparently had enough information to know this guy should be off the campus if he didn’t get mental help. They knew people were purposefully sitting by the door so they could run fast in case this guy did something. This guy clearly struck people as dangerous.

In Arizona the laws are fairly liberal compared to other states. In lots of states the only way you could act on this is if he had demonstrated dangerousness to self or others. But in Arizona, it would have been legal to involuntarily take him to the clinic and have him evaluated. People don’t do this much, because we’re very concerned about people’s civil rights. How do you weigh the fears of a college atmosphere against the civil rights of the individual — an individual who will go in and say, “Look, I might be a little strange, but there’s nothing really wrong with me”?

That’s a key question. Did the college behave properly? Should the school have mandated some sort of mental health treatment for him, rather than kicking him out?

Legally, they could have. Whether they should have or not depends on who had what information and what it looked like at the time. The retrospect-o-scope is a hundred percent.

Exactly. The people around Loughner had only piecemeal information, the impact of which is “obvious” only now that we know how the story ends.

But that’s not the only problem colleges face. For one thing, the actual contact hours a professor has with students are pretty limited. I typically see a student four hours per week (unless they’re taking more than one class with me, the poor dears!). Loughner gave off enough scary vibes that the instructor reported him and the college ejected him until he got treatment. That didn’t happen at Virginia Tech, where as far as I know just one instructor was alarmed enough by Seung-Hui Cho to advise him to seek counseling.

In my eight years of teaching, I’ve had a handful of students who were disruptive of classroom dynamics. There was one guy I considered my “mini-MRA,” who belligerently challenged every idea I presented, but also seemed to think he could kiss up to me by calling me repeatedly at home. Another apparently aspired to become Jonah Goldberg’s clone. But I’ve only had one who gave me an intensely uncomfortable vibe. He talked about how people thought ill of him because he liked to wear a trenchcoat, just like the Columbine shooters. I spotted him again on campus about five years after I’d taught him, and I wondered if he’d had to stop out for mental health reasons. As a new instructor back in 2002, I just thought he was creepy and eccentric. Today, in the post-Virginia Tech era, I’d probably consult with a campus counselor.

But actually reporting someone isn’t a simple matter. Will the student retaliate once he’s put under a microscope? One of my graduate advisers was stalked for many months by a former student, and she had only given him the low grade he’s earned. Loughner, too, acted out when he didn’t get the grade he wanted:

Even in his gym classes, there were problems. In May, the police were called by Mr. Loughner’s Pilates instructor, Patricia Curry, who said she felt intimidated after a confrontation over the B grade she wanted to give him. She said he had become “very hostile” upon learning about her intention. “She spoke with him outside the classroom and felt it might become physical,” the police report said.

Ms. Curry told the police she would not feel comfortable teaching Mr. Loughner without an officer in the area, and the officers stayed to keep watch over the Pilates class until the class ended.

Ms. Curry must have been alarmed indeed to call the police. In her place, I’d be even more frightened about retaliation after class.

The danger of retaliation would be great if the student weren’t treated or didn’t adhere to his treatment. My university does offer psychological services, but they’re woefully understaffed. Severely depressed students are routinely told to wait a month until they can see a therapist qualified to prescribe medications. This has occurred even when the student was suicidal, and said so. Multiple students have told me that they sought help and endured a long wait to get in, only to find they had no rapport with their assigned counselor. One rape survivor told me her sessions were downright counterproductive. Much of the counseling is provided by graduate students. The experienced therapists are quite good, I think, but they’re far too few in number.

Pima College, where Loughner took classes, provides no mental health services. It has over 68,000 students. Much of Loughner’s behavior was bizarre rather than threatening – for example, insisting that the number 6 was actually 18. I can understand why they Pima expelled him but didn’t petition to have him involuntarily committed.

One of the New York Times articles makes the argument that colleges can keep a closer eye on troubled students if they remain enrolled. That’s true as long as students are in dorms. (Incidentally, the same holds true for substance abuse problems.) But when a student lives off campus, we cannot expect an instructor – who in community colleges may teach four or more classes – to keep tabs on a student she sees only four or five contact hours per week. Pima is not a residential school. Did I mention it has 68,000+ students?

It’s striking that no one is asking why Loughner’s former restaurant employers didn’t call in the state. Or why the dog shelter where he volunteered didn’t so the same. Or the Army! All of these entities recognized that Loughner had serious issues. The Army rejected him for having a drug arrest. Quiznos fired him for bizarrely refusing to respond to a customer, and his manage recognized a “personality change.” At the shelter, he exposed puppies to parvovirus after being clearly told to keep them out of a contaminated area. But the New York Times is not asking why these entities didn’t intervene.

I think the difference is that Americans still expect colleges to operate in loco parentis. Even residential colleges haven’t really borne that responsibility – or wielded that power – since the 1960s. We no longer have housemothers and curfews. Young people 18 and older aren’t legally children. Universities can’t act like their parents. Especially when the student is still living at home with his parents.

I don’t want to indulge in blaming Loughner’s parents. His father is reportedly an unpleasant fellow. They still deserve pity and compassion. They have lost their only son forever.

But we surely cannot expect an underfunded, overgrown community college to stand in for his parents, either.

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Gratuitous flowers for a sex post: Cascading morning glories captured by me, Sungold, in October, back before the frost bit ‘em.

The Denver Post ran an article today asking why an arousal-booster for women called Zestra can’t find TV stations willing to run their ads, even as Viagra ads are literally driving in circles around us. Historiann took the article to task for its casual disavowal of feminism, and I’ve got nothin’ to add to her critique except a vigorous nod of approval. Figleaf chimed in to say that the stations’ ad policies spotlight the illegitimacy of autonomous female desire.

What most struck me about the article, though, was its conflation of libido and arousal, which is endemic in “science writing” that reports on “pink viagra.” Here’s how reporter Mary Winter framed it:

Now, you would not know it from the $300-million annual ad campaign for erection-enhancing ads for Viagra, Cialis and Levitra, but women suffer more sexual dysfunction than men do — 43 percent to 31 percent, according to the Journal of the American Medical Association.

In other words, the potential market for flagging female libidos is huge. But here’s the irony: When the makers of Zestra went to 100 television networks and stations to buy ads, the vast majority refused them. The few stations that did take their money would run the ads only after midnight or during the daytime.

The stations “told us they were not comfortable airing the ads,” Zestra co-founder Mary Jaensch told “Nightline.” The double-standard here — men, you deserve sexual pleasure, and women, what’s wrong with you hussies? — is breathtaking.

So how about this ad: a Camaro, a woman, and a vibrating driver’s seat?

(This is just the end of the article; read the whole thing here. Winter is very sharp and witty on the Viagra ads!)

In a way, it’s unfair to pick on Winter, because most writing about female sexual dysfunction fails to draw basic distinctions between arousal, orgasm, desire, and libido. It also tends to ignore the reality of the physical pain some women experience (which K has explored eloquently at Feminists with Female Sexual Dysfunction.) In practice, women can of course have issues with any or all of the above, and problems in one area can easily spill into another. A woman  suffering from vulvodynia, for instance, might be able to orgasm, but if sexual activity hurts, that’s likely to dampen her libido. Another woman might have a generally low libido (meaning she doesn’t crave sex very often) but develop desire responsively to her partner, at least in certain situations. There are probably as many variations as there are women.

Now, getting back to Zestra and the Denver Post: Winter’s article refers mainly to libido. She’s partly on the right track, insofar as that “42 percent” figure refers mainly to women who complain about low libido. (Some feminists have criticized that figure as too high, but let’s set that debate aside for today.) Winter does hint at the primary issue here – arousal – in that apparent throwaway line about a vibrating driver seat in the Camaro. Why yes, I think quite a few of us gals might enjoy such a ride! But if we got a good buzz per gallon, that wouldn’t mean our libido was revving – only that our engine was purring smoothly.

Libido is not the primary target for Zestra, though Zestra’s website refers to a whole host of potential benefits: stronger libido, greater satisfaction, more earth-shaking orgasms, and a more harmonious relationship with one’s partner. (That last point comes up only in testimonials; the overall tone of the website is “try this for yourself,” not “use this to please your long-suffering husband.”) It’s being marketed to women who suffer from sexual problems of any sort due to illness (including cancer), postpartum changes, menopause, antidepressants, stress, and even widowhood. But what does it really do?

Zestra’s primary mechanism, as far as I understand it, is to enhance arousal and response during sexual activity. As far as I can see without having tried it myself, it looks like it might increase engorgement and/or creaste prickling sensations in a nice way. In the best case, yummy sensations start a cascade of increasing desire during lovemaking. As a topical agent applied directly to one’s ladyparts, Zestra doesn’t act directly on libido, which is regulated by the brain and a complex dance of different hormones and neurotransmitters (including estrogen and testosterone, but also thyroid hormone, stress hormones, dopamine and lots of other nifty “messenger” chemicals). A topical gel won’t directly influence that chemical brew. It’s only logical, though, that if sex is more pleasurable, some women might want it more. Biological anthropologist Helen Fisher has written about how hot sex with a new partner gives us a dopamine high akin to cocaine (quick summary of her ideas here). Maybe hot sex with in a newly reinvigorated relationship can give us the same buzz?

Also, the testing for Zestra relied on women who committed to have sex eight times in a month, so it’s unlikely many of them had a super low libido. (For more details on the testing, check out the clinical study.) These women were already open to regular sex. As a group they sound to me more like women who basically like sex but were frustrated by difficulty getting aroused. They don’t sound like the subset of women who’ve given up on sex – a group that constitutes about 15% of American marriages, by the way. (This according to Tara Parker-Pope in the New York Times, where “sexless” was defined as no sex at all with one’s spouse during the previous six to twelve months.)

In other words, the mechanism behind Zestra appears to be entirely different than flibanserin, an orally-administered drug recently rejected by the FDA for ineffectiveness. Flibanserin was supposed to increase libido directly by changing one’s brain chemistry. It too was compared to Viagra, and quite wrongly so: Viagra targets a mans plumbing, so to speak. It produces an erection (though it almost always requires mental and/or physical stimulation to be effective). Flibanserin left physical arousal untouched while aiming to increase psychological arousal and desire.

Calling flib a “pink viagra” was just misleading. In the case of Zestra, the comparison appears more apples-to-apples, since both Viagra and Zestra appear to work by increasing engorgement.

I still think it’s too bad that flib flopped. Yes, the drug was intended to be a Big Pharma Bonanza. I don’t really give a shit. If it had really helped women live better, I’d be all for it. I trust women to make decisions about their bodies (though I also insist on our responsibility to understand our bodies. At any rate, flib failed to gain FDA approval because it didnt work.

As far as I know, there’s still nothing  on the market that specifically helps women who only desire sex once in a blue moon. For some women, hormone therapy (sometimes including testosterone as well as estrogen) delivers a libido boost. But hormones carry some risk. Women fear breast cancer if they take estrogen and they fear growing a beard and unibrow if they take T. But these are the choices, because there’s no drug that specifically targets libido.

Zestra interests me because it seems to be quite safe (worst side effect: transient burning sensations in some rather precious real estate). I’m skeptical to the extent that their studies are pretty small. Unavoidably, the very fact of running a study is an intervention in itself. This can have real effects on its findings. How many of the couples studied would have had sex at least eight times in a month? If most would’ve had less, that means Zestra wasn’t the only independent variable. Perhaps the twice-weekly commitment, combined with a new toy or just wall-to-wall pictures of George Clooney and Jon Hamm would fire their engines just as well. I’m pretty sure I’d be off and roaring on that program! (Where do I sign up?)

Seriously, I have been meaning to try Zestra just for the fun of it, since it sounds like its potential benefits might not be limited to people suffering from difficulty with arousal … and, y’know, anything for science! I’ve got a packet of it in a drawer but I’m not so sure what my lab partner would think.

As always, I’m very curious if any of you out there in bloglandia have given Zestra a whirl? And if so – are you willing to dish? Pretty please?

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