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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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Earlier this week, I talked to my husband and kids, who are keeping the fires burning in Ohio while I’m visiting family in California. All of them were aggrieved. My husband was planning to fix broccoli and noodles for dinner. Both boys were insisting that they would not eat it and furthermore never had liked broccoli. Never mind that two reliable witnesses (both of their parents) have seen them eat it with gusto! The standoff ended when the broccoli was discovered to have both mold and bugs.

You might imagine that this was simply an instance of children being picky and ornery. You would be wrong. New research shows that I am to blame!

When I saw the headline on the medical news wire Ivanhoe – “Pregnancy Diet Predicts Food Choices of Children” – I figured it would insinuate that mommy is at fault. But the actual article was much worse. It managed to blame mothers directly in its very first sentence:

If you’re a mother to a finicky child, then you may be to blame for his or her picky taste.  A new study conducted at the University of Colorado School of Medicine uncovers the possibility that a mother’s diet during pregnancy can both familiarize the unborn baby with specific scents and tastes and directly influence what the child will later prefer to eat or drink.

“This highlights the importance of eating a healthy diet and refraining from drinking alcohol during pregnancy and nursing,” lead researcher Josephine Todrank was quoted as saying.  “If the mother drinks alcohol, her child may be more attracted to alcohol because the developing fetus ‘expects’ that whatever comes from the mother must be safe.  If she eats healthy food, the child will prefer healthy food.”

I’m dizzy with those leaps of logic. How did we jump straight from food to alcohol – the kryptonite of mother-blaming? And how many children are attracted to alcohol, anyway? Yes, fetal alcohol syndrome is a serious problem among the offspring of binge drinkers. I don’t see a lot of kids clamoring for a glass of Merlot. In fact, we’ve let our kids taste beer and wine, when they expressed curiosity, just so they could discover that it tasted “pooey” to them.

Read a little farther and you learn that Todrank et al. tested their hypothesis on newborn mice. For better or worse, mice don’t have much of a culinary culture. They aren’t tempted by the toys in Happy Meals. Nor are they exposed to my delicious vegetarian chili. Even in terms of the mouse lifecycle, one wonders whether the pups acquired a broader range of tastes as they grew. Also, mother mice are never told to drastically limit their diet while breastfeeding due to a colicky or restless pup.

My firstborn child tolerates much more spice than I do. He eats chard and Thai curry and Kalamata olives with gusto. My second son? He’d live on candy, breakfast cereal, hard-boiled eggs, Kraft mac-n-cheese, and more candy if we’d let him.

If this study has any applicability to humans, you’d expect to see the same pattern in every family: the firstborn should be a foodie, while subsequent children – conditioned by the relatively bland diet that families often adopt while feeding a toddler – should be pickier. You’d also expect the children of my spice-loving friends to be omnivores, yet many of them are pickier than my younger son.

It may well be that the biological effects on taste and smell that Todrank et al. found in mice have some applicability to humans. If so, it’s heavily filtered through culture. As parents generally know, young children usually have much more restricted tastes than their parents. I, for one, forced myself to eat broccoli during pregnancy even though it triggered nausea – and look where it got me!

Can we stop with the mother-blaming already? Most women consume a reasonably well-balanced diet during pregnancy. The few who don’t are usually either poor or plagued by hyperemesis gravidarum (that’s medicalese for uncontrollable barfing). Let’s not make mothers feel guilty because they failed to eat their brussel sprouts.

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The other day, I googled “cold flashes.” That wasn’t a typo; I didn’t mean “hot flashes.” I meant COLD.

I’m not at menopause yet, and judging by family history I’m probably a good half-decade away. But over the past several years I’ve had even more trouble than usual staying warm. My internal thermostat went completely haywire when I got sick in January 2009 with the still-undiagnosed ailment that messed with my nerves and muscles and brain. Nothing could keep me warm. While that has improved somewhat, it hasn’t returned to my pre-illness state. Then, after a minor virus this fall, I started to notice that warm stimuli – the blessed touch of sun on skin, or the spray of hot water in the shower – could give me the chills. Goosebumps, even!

I wasn’t alone. A friend of mine, a few years younger than I, seemed equally miserable at those chilly soccer games at the end of this fall’s season. We were both hiding under blankets and nursing a thermos of tea as soon as temperatures dropped into the 50s.

I began to wonder: might freezing just be part of aging?

According to Google, yes. Women do report cold flashes, though they typically follow upon hot flashes. Somehow, the hot flashes, with their dramatic sweats and red skin, get all the press, while the chills get – well, the deep freeze in the media!

The root cause seems to be the same, though. The hypothalamus is responsible for keeping our internal temperatures running steady. In the decade or so prior to menopause (a woman’s last period), the hypothalamus stops running so steadily. Conventional wisdom holds that fluctuating estrogen levels send confusing signals the hypothalamus, but actually there’s an intricate interplay between the hypothalamus, pituitary, and ovarian hormones. Contrary to its image, estrogen does not function as the ringmaster – not on its own, anyway.

Whatever the exact mechanism, it sure feels like a broken thermostat to me. At the blog re:Cycling, Heather Dillaway objects strenuously to calling it broken, or attempting to “fix” it. She objects to any language that portrays menopause negatively or suggests that women “suffer” from it. She’s part of a noble tradition of feminist criticism that has pilloried the medicalization of women’s bodies. This critique, however, too often sets up a false opposition between how doctors tell women they should feel and women’s actual experience.

Sure, experience is partially shaped by our expectations, including biomedical ideas about women’s bodies. Menopause is indeed a natural transition, one that every cis-woman will undergo if she doesn’t die young. We should certainly oppose the idea that women’s worth is based on their youth, beauty, and fertility. We should celebrate the wisdom that can come with time.

But doggonit, my thermostat feels broken! I might fantasize about it improving if were to spend a week in St. Tropez, but realistically? It’s likely to get worse before it stabilizes or improves. And it’s not a trivial thing. When I’m unable to get warm, despite long underwear and a sweater, a heating pad, and an ambient temperature of 72, I don’t merely experience cold; I suffer it. Putting a positive spin on this merely denies my experience. To anyone intent on painting menopause in shades of rose and mauve, I ask: What color do they turn when they freeze?

For many women undergoing the menopausal transition, temperature regulation is only one challenge. Many women also report debilitating fatigue, which is also linked to a wonky hypothalamus. They wake up at night, drenched in sweat, heart racing. It’s not a panic attack; it’s “only” a night sweat.  Salon just ran an essay by Beth Aviv detailing her struggles to manage such symptoms after (admittedly foolishly) stopping hormone treatment cold turkey:

… I wake in the middle of the night, heat percolating to the surface like an underground spring — flooding between my fingers, into elbows, under my arms, onto my chest, my neck, my scalp until my straightened hair curls. If you could slide your fingers over my forehead, it would feel like you were finger-painting. Sleep does not return for hours.

The comments on Aviv’s essay are Salon’s usual mixed bag. There’s no shortage of people telling women to just “suck it up.” (This phrase appears repeatedly.) It’s mostly women piling on other women, as in this especially judgmental comment by a woman calling herself Semolina:

Most menopause symptoms are psychological. Some people enjoy making drama out of trivial events, and those are the folks who suffer mightily. I’m sixty years old and female and none of my friends has had this extreme problems — because I don’t hang out with drama queens.

Well, that Judgey McJudgey comment drew the smackdown it deserved from another commenter named Mona:

I see. Well, I am a 54-yr-old woman with a law degree from an elite university. A bit more than a decade ago, I suffered a severe emotional breakdown in the wake of the death of my oldest son via vehicular accident. Followed by that son’s father deciding to leave me for a man — that happened 6 weeks after we buried our 19 year old son.

As a consequence, I developed a crippling anxiety disorder. I’ve been in peri-menopause or menopause for about 8 years, and had been swimming right along assuming mine would be as easy as my mother’s.

It is now NOT. And it’s not in my head. It’s in the interference with my work toward recovering and living an emotionally stable life — a life with joy.

The extreme insomnia is not in my head. Nor the heart palpitations and the profuse sweating followed by cold clamminess ALL NIGHT LONG.

So, Seminola, I’m glad you don’t hang with “drama queens.” Neither do I. But some women have had, and continue to have, serious, dramatic problems that are, most decidedly, not in our heads. Or wait, they are, but not in the way you imperiously meant.

Now, obviously most menopausal women don’t undergo two personal tragedies in quick succession (though most of us do start to notice the losses piling up as we move through our forties). I’m offering Mona’s experience not to typify menopause, but to underscore its variability. She thinks she’s going to try bioidentical hormones, which I would likely try myself in her situation. (The debate on the relative safety of “bioidentical” versus synthetic and equine-derived hormones is not one I want to engage here – maybe in a future post?)

It’s great that some women sail through menopause, getting by with a sense of humor and a willingness to just suck it up. That’s their experience. I’m glad they were able to manage. I’m still early-days enough to fantasize it could be my experience, too, especially if I keep my house well heated.

But other women have other experiences. Some experience severe cognitive and mental health issues. Most face the more mudane – but still sometimes disabling – issues of body temperature regulation and insomnia. Oh, and sexual issues, but that would be a whole ‘nother post.

Point is, nobody gets to define your experiences for you. Not the perhaps well-meaning but ultimately wrong-headed doctors in the 1950s and ’60s who promised eternal femininity. Not those present-day doctors who fail to see patients as individuals, either demonizing Prempro (the most common synthetic HRT) or withholding it across the board. Not good-hearted feminists who want to put power back in women’s hands – but haven’t walked in your shoes, nor tried to sleep in your soggy sheets. Certainly not the Internet scolds who tell you to suck it up.

You. Only you get to decide what you’re experiencing, whether you’re suffering, whether something feels “broken,” and how – if at all – you might try to fix it.

Then again, maybe I’m a drama queen, and I just haven’t noticed it?

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When the TSA first announced its rollout of body-scanners, my first thought was: What about privacy? My second: Are they safe?

While privacy is obviously and inarguably a massive issue, the facts aren’t quite as evident on the question of safety. Back in January, Lindsay Beyerstein made the point that one of the two types of scanner – the “backscatter” technology – uses x-rays, yet the machines are not subject to the sort of rigorous testing expected of medical equipment. Even CT scanning equipment, which is operated by trained medical personnel, has resulted in a distressing number of overdoses from wrongly calibrated machines, some of which were uncovered only after the FDA and the New York Times launched an investigation starting in late 2009.

TSA employees have no medical training – none! – and we have no reason to believe that they are prepared to recognized machine malfunctions. Indeed, they are so unprepared that one TSA employee told a pregnant traveler that the machines emit less radiation than do sonograms – a stunningly ignorant statement, given that ultrasound doesn’t rely on x-rays at all. (The pregnant woman was subsequently bullied into the body-scanners by repeatedly refusing her a pat-down.)

Lindsay also raised the question of cumulative radiation. How much is safe? I would argue that no matter how small the dose of x-rays, it is only justified if it will save lives, and if safer techniques would not produce the same results. The Israelis manage to make it work without routine body scans, primarily through painstaking intelligence on potential terrorists – no x-rays needed. (Link via the excellent overview of issues at Sister Sage.)

My husband has had cancer twice. It was treated with radiation the first time around. He’s had lots of CTs – too many – and caught some of the fall-out from Chernobyl back in 1986. He does not need any extra x-rays. My kids don’t need any extra x-rays. Nor do you or I, dear reader.

If I were a TSA employee on the front lines, I’d also want to know how much of an occupational risk I was running. On the one hand, the intensity of the radiation is purported orders of magnitude less than used in medical x-rays. On the other hand, what’s to keep the x-rays contained? The name “backscatter” is not reassuring on this score. TSA operators are spending entire workdays in close proximity to these devices.

The other type of strip-scanner does not use ionizing radiation. It relies on millimeter waves. Some questions have been raised as to the safety of terahertz waves, which may have the potential to essentially “unzip” DNA, but terahertz waves are not identical to millimeter waves, just adjacent to them in the spectrum. (Two abstracts on terahertz waves are here and here. My main takeaway is that their safety is not yet well researched.)

On its website, the TSA simply asserts that millimeter-wave technology is safe; it does not supply any data or link to any studies. I just ran a PubMed search on “millimeter waves” and “safety,” which turned up only six hits, only one of which seemed relevant. A review article in Health Physics from 2000 raised the question of whether occupational exposure (that is, of the sort some TSA employees experience) could result in hazards such as burns or cancer; I can’t access the full text, so I don’t know what they concluded.

It is striking, in any event, that PubMed yielded so little information on the safety of millimeter-wave scans. Business Week reports that their health effects are “largely unknown,” and that the president of the National Council on Radiation Protection and Measurements favors conducting a study that would assess their safety. Much of the information on the web conflates millimeter waves with the terahertz spectrum and thus appears less than trustworthy.

In short, the TSA may be correct that the low intensity of the energy from both types of scanners makes them unlikely to create a real health threat. If I were a frequent flyer or a flight crew member, I would still wonder why there’s so little hard information on their safety.

More importantly, I worry about a the lack of medical/technical oversight. Largely uneducuated low-level employees are operating these scanners. If a scanner were wrongly calibrated and delivered much higher doses, who would know?

At the end of the day, I still think the best health-related objection to the strip-scanners comes from Revere of the now-dormant but wonderful blog, Effect Measure. Revere applied his skills as an epidemiologist. He noted that any machine purporting to catch every would-be terrorist will have a substantial number of “false positives” – people who are flagged though they’re innocent. Precisely that is now occurring, as evidenced by the story of passenger Christine Holland (who subjected to a grope-search after the scanner suggested she was carrying contraband). Revere calculated how many false alarms would be raised by a machine with only a 1 in 100,000 false positive rate:

According to the Department of Transportation, during the last year there were about 710 million enplanements (US carriers, October 2008 – September 2009; excludes all-cargo services, includes domestic and international). That would produce 7100 false alarms, about 20 a day. How many passengers carrying explosives would the technology pick up? Well, we’ve had exactly 2 since 2001 (Richard Reid the shoe bomber and the current underpants bomber), or .25/710,000,000 enplanements (it’s actually less because enplanements have decreased substantially since 2001). So the probability of an alarm being correct is about 1 in 30,000 or .000033.

(Read the whole thing here.)

I swear Revere argued at some point that screeners will eventually become inured to false positives and thus won’t be alert if a real threat were to appear. I can’t find where he said that, but it’s a key point, so I’ll make it anyway. Add to this the tremendous waste of resources that goes into checking for liquids and gels, printer cartridges, baby formula, and other innocuous items. Now add the diversion of TSA energies toward thoroughly frisking and groping everyone from Jeffrey Goldberg to little kids.

In other words, the biggest health risk from the scanners is that we’re actually less safe from terrorists than we were before. Anyone else feeling queasy yet?

[Variation on my usual "I'm not a lawyer" disclaimer: I'm also not an M.D., a physicist, or an epidemiologist.]

Update 11/14/10, 9:40 p.m.: According to Agence France Press, serious scientists have raised concerns about the x-ray machines. Michael Love, a scientist who runs an x-ray lab at the Johns Hopkins medical school, stated that “statistically someone is going to get skin cancer from these X-rays.” In April, scientists at UCSF wrote the White House Office of Science and Technology, saying, “While the dose would be safe if it were distributed throughout the volume of the entire body, the dose to the skin may be dangerously high.”

Update 11/15/10, 11:10 p.m.: Here’s the full text of the letter (.pdf) from the UCSF scientists. The potential health risks it outlines are compelling enough that I’m not about to let my kids go through a backscatter machine. I’m also floored by how little study has been done on their safety.

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So let’s say you’re seeing your doctor, whether for a checkup or an acute problem. She looks you over carefully. Just on the basis of your appearance, she decides you’re at risk for significant health problems.

Sure, most readers of this blog are aware that appearance counts for a lot (too much!) when it comes to work and dating. But in the doctor’s office? Did you know that one common measure of health is whether you look your age? For all the time I’ve spent studying medicine, this practice was new to me.

Researchers at St. Michael’s Hospital in Toronto report, via Eurekalert:

“Few people are aware that when physicians describe their patients to other physicians, they often include an assessment of whether the patient looks older than his or her actual age,” says Dr. Stephen Hwang, a research scientist at St. Michael’s Hospital and an associate professor at the University of Toronto. “This long standing medical practice assumes that people who look older than their actual age are likely to be in poor health, but our study shows this isn’t always true.”

For patients, it means looking a few years older than their age does not always indicate poor health status. The study found that when a physician rated an individual as looking up to five years older than their actual age, it had little value in predicting whether or not the person was in poor health. However, when a physician thought that a person looked 10 or more years older than their actual age, 99 per cent of these individuals had very poor physical or mental health.

(Read the rest here.)

Where I live – in an Appalachian county in Southeast Ohio – I suspect you actually do see lots of people who look a decade older than their chronological age. I’m basing this on anecdata gathered partly while in the waiting room at the ob/gyn’s office, where grandmothers-to-be often accompany their young pregnant daughters. I live in a pocket of endemic poverty. Poverty does beat people down. It ensures that they’ll grab cheap, satiating calories over a bunch of colorful veggies – just because it’s not pleasant to go to sleep at night with a gnawing sensation in one’s belly. We know that diabetes, for instance, is rampant in this region. So is extreme obesity.

But the pitfalls of using appearance as a proxy for health ought to be obvious, too. Take, for example, your faithful blogger Sungold, whose miraculously youthful complexion is due to … being born near the 49th latitude with her head in a book. I think I probably do look a few years younger than my age (especially compared to the local population) just because I didn’t get much sun as a youngster. But does that mean I’m healthy? Long-time readers know that I’ve got something undiagnosed, which is sort of like fibromyalgia and a bit like thyroid issues and a mimic of multiple sclerosis – but is apparently none of the above.

People who have a medical problem but look healthy are not well served by this rough-grained appearance test. Doctors will tend to dismiss their complaints because hey, they don’t look sick.

People who look much older than their actual age may also be poorly served. For example, too many doctors address problems like obesity on a radically individualized level, often with a dollop of shaming for letting oneself get too fat. The people in my region look old because they face multiple oppressions. Whatever wise or foolish decisions they’ve made in the past, they need a doctor to propose constructive solutions, not prejudge them based on appearance.

I hope doctors will take this study to heart and move toward evidence-based medicine when it comes to appearance. By all means, if someone looks extraordinarily aged, use that as a reason to inquire further. But do inquire. Please do ask. Appearance can only project a 2-D image. Patients’ words and embodied experiences can supply the essential third dimension.

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This USA Today headline is one of the most annoying I’ve seen in a while:

It’s true: Menstruation does affect women’s emotions

And no, I’m not irked because I’m PMSing. In fact, if it’s not TMI, I’m in the “follicular phase,” which the study cited in this article claims is the least emotional phase of women’s cycles!

Here’s what the study actually found.

Researchers used MRI to study the brains of women who viewed a series of pictures and rated them as pleasant, unpleasant or neutral. This test was repeated at different stages of the women’s menstrual cycles.

In the early follicular stage of the menstrual cycle, no areas of the women’s brains showed significantly increased activation while viewing the pictures. But during the midpoint of their menstrual cycle, when hormone levels were higher, the women had increased activity in the lateral prefrontal cortex and other areas of the brain involved in processing emotional information, the researchers found.

So no, it’s actually not menstruation that makes women more emotional, assuming the study’s findings turn out to be valid. It’s ovulation! And the hormones that accompany ovulation! Because that’s what happens at the “midpoint” of the cycle.

In fact, the article says nothing whatsoever about what happened in the brains of women who were actually menstruating or on the verge of it. The headline nonetheless preys shamelessly on the stereotype of the moody menstruating woman. Some of us do get moody, and that’s okay – but all women are not the same. (Also, this may be pedantic, but it’s sort of simplistic to say that “hormone levels were higher” at mid-cycle. It depends on which hormones you mean. First estrogen peaks, then progesterone hits its maximum several days later.)

Apart from the misleading headline, the study itself makes me wonder if function MRI technology is feeding into a kind of “physics envy” among psychologists, biologists, and biomedical researchers. Biologist and primatologist Robert Sapolsky offers my favorite explanation of physics envy:

This is a classic case of what is often called physics envy, a disease that causes behavioral biologists to fear their discipline lacks the rigor of physiology, physiologists to wish for the techniques of biochemists, biochemists to covet the clarity of answers revealed by molecular geneticists, all the way down until you get to the physicists who confer only with God. Recently, a zoologist friend had obtained blood samples from the carnivores he studies and wanted some hormones in the samples tested in my lab. Although inexperienced with the technique, he offered to help in any way possible. I felt hesitant asking him do anything tedious, but since he had offered, I tentatively said, “Well, if you don’t mind some unspeakable drudgery, you could number about a thousand assay vials.” And this scientist, whose superb work has graced the most prestigious science journals in the world, cheerfully answered, “That’s okay. How often do I get to do real science, working with test tubes?”

(From Sapolsky’s wonderful essay on testosterone.)

Obviously, MRI is way cooler than test tubes! It’s no wonderful that researchers would rather get big grants and fiddle with fMRI, because it not only seems like “real science.” Grants and equipment tend to impress tenure committees, as well. While we actually know very little about what – if anything – fMRI actually tells us, it makes for cool pictures of the brain and imposing CVs.

But surely I’m not the only person who read about this latest fMRI study and wondered: Golly, couldn’t the researchers just ask the women how they were feeling?

 

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The controversy about the term “birth rape” has ebbed in the blogosphere (which has a shorter attention span than my seven-year-old son). But that doesn’t mean I’ve stopped thinking about it. Nor, it appears, have other people. A reader named Ann took the time today to disagree with me vehemently:

To me there is not the slightest smidgeren of doubt that the women who state that they were raped, indeed were raped. Rape is NOT, absolutely definitely NOT only about sexuality. It is mainly about power and dominance. You will find very few among the BDSM community who are not aware of this.

Rape can – also – occur in the total absence of a feeling of guilt of the perpetrator. Whether a nurse, midwife or doctor think their deeds are justified because they have a right to go home early, or that woman birthing is too dumb or distraught to know what she wants, or whether a pedophile reasons that the 5 year old boy “wants it” because he happened to leave his knickers off, or whether the husband holds his wife down, thinking she’ll eventually come around, it all does not matter. It still is rape.

(Read the whole comment here.)

I fully agree that rape is not just about sex but about power. However, by its very definition, rape is about sexualized power. The abuse of medical power has to do with power too, but it has little or nothing to do with sexuality. (An exception would be a doctor who subjects patients to sexual touching – which most definitely belongs on the continuum of sexual assault, and which happens with distressing frequency.)

A doctor who violates consent is not acting from the same motivations as the pedophile. He or she is supported by our cultural values in ways that a pedophile is not. Yes, we live in a rape culture, but you would find very few defenders of a pedophile. By contrast, medicine enjoys partial immunity from criticism because of assumptions that lay people cannot understand it, that medical personnel always hold humanitarian values, and that they will always act in the best interests of the patient.

Of course, this isn’t true. Consider another truly vile category of gynecological violation: forced sterilizations. Doctors in Nazi Germany sterilized about 400,000 women and men, the vast majority of them against their will. About half of the victims were women. The Nazi program was inspired by smaller-scale compulsory sterilization programs in the United States, whose legality the Supreme Court affirmed in its 1927 decision in Buck v. Bell. Compulsory sterilization declined after 1942 in the U.S., but poor women of color have still been subjected to it in the post-war era, most notably in Puerto Rico and on Indian reservations.

There seems to be a common conception that if declining to recognize a phenomenon as rape is the same as trivializing it. And yet, we don’t call forced sterilization “rape,” nor should we. Doing so would obscure its specific nature. It would draw attention to the particular values that legitimated it: the pseudoscience of eugenics, contempt for disabled people, and society’s exaggerated deference to medical authority.

In short: something can still be an atrocity if it’s not called rape.

Insisting on accurate naming is not “language policing,” contrary to what Cara argued at The Curvature:

I also thought that a big part of anti-rape activism was about broadening our definition of rape, not narrowing it — throwing out the stranger jumping from the bushes with a knife as the only model of rape, and recreating a model that encompasses a wide variety violent experiences and promotes affirmative, enthusiastic, meaningful consent as minimum standard of decency rather than a nice bonus if you can get it. I thought that anti-rape activism was about acknowledging that rape is not just one thing, that there is more than one way to violate a person and to be violated, and that whether consent was given was more important than how much force was used. Especially in this context, the posts in question come off as nothing more than language policing, against particularly marginalized populations, no less.

(The rest of the post is here.)

First, I think we should be able to discuss the applicability of “rape” to specific phenomena without shaming other feminists as rape apologists, or saying that they are acting as oppressors, or blaming their words for harming victims. That happened in both Cara’s post and the comments to it. Critique is good; disagreement is healthy. But shaming only leads to groupthink, as the comment thread to that post shows. Only one commenter deviated even slightly from Cara’s position.

I actually don’t think that anti-rape activism is “about broadening our definition of rape” – not if this means extending the term into entirely different realms of violence that are not basically sexual. Of course I strongly support recognizing acquaintance rape, or marital rape, and other instances of sexual violence as just as real, traumatizing, and illegal as the “stranger in the bushes.” But “rape” is not an infinitely elastic term, nor should it be.

Specific names for specific violations are politically and analytically important because they push us to understand the roots of different forms of violence. In cases of medicalized violence, we need to consider the values that enable a scenario like this one, described at the blog Forever in Hell:

The problem isn’t that women in labor are uniquely in a position to be victimized by medical professionals. The victims of such medical professionals are not uniquely women in labor. In other words, you don’t have to be a woman in labor to be victimized by a medical professional. You simply have to be in a room with certain medical professionals.

Case in point: a friend of mine needed a lumbar puncture (spinal tap) in order to tell if he had Multiple Sclerosis or Lyme Disease. These two diseases can cause similar symptoms and similar MRI results, but have vastly different treatments, so distinguishing between the two is necessary. My friend is a large man, so he needed to have the lumbar puncture done at the hospital by a doctor.

Before the procedure began, the nurse told the doctor that the needle they had was too large, they needed to get another. “Too bad,” snapped the doctor. He had a schedule to keep, he had a golf game to get to. Waiting for someone to get the correct needle would take too long, so, before my friend could object, doctor forced the needle into my friend’s spine. When I say “forced”, I mean forced.

I could hear him scream from down the hall.

Then, to add insult to injury, the doctor refused to draw enough cerebral spinal fluid to allow for two tests. “We’ve got enough to test for MS, what more do we need?” he said.

That’s right. This doctor tortured a man so as not delay a golf game and didn’t even get the damn test done.

(The whole post is here.)

I don’t agree that doctors are the only offenders (as this post goes on to argue). The potential for abuse is greater among those who are more powerful, but other medical personnel aren’t outside the value system that enables medical battery.

But this example does show that the problem really is primarily with the values that underlie medicine. Yes, we’ve come a long way from the days when a white coat commanded automatic obedience. We have the patients’ rights movement to thank for that, which was driven in large part by feminist critics of medicine. However, as long as medical personnel remain unaccountable for violations of consent, some practitioners will abuse their power.

If we want to stop battery of women in childbirth, we’re not going to make much headway by combating rape culture. We need to call for more humane and democratic medicine. We need to demand medical education that would weed out arrogant abusers and reinforce respect for the patient. We need to insist that doctors hold each other and their subordinates responsible – and if they can’t, or won’t, the law needs to intervene, with civil or criminal remedies as appropriate.

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(TMI alert, especially for the medically squeamish, and trigger alert for medical violence.)

The story of how I birthed my first child is a far cry from the dimly-lit, romantic scenarios pictured in hospital brochures and natural birth guides alike.

The Bear got stuck before his head was even properly engaged. I was in Germany, so you can’t blame what happened next on medicalized childbirth, American-style. I did have an epidural (at my own request, nay, demand!) and enough Pitocin to deliver a small elephant. My midwife tried acupuncture. We tried every possible position: all fours, squatting, draped over an elevated bed with my head hanging down. I even swallowed some homeopathic remedy. This was Germany, after all.

Still, he was stuck. After seven hours (!) of being fully dilated – which is four or five hours longer than a U.S. ob/gyn would tolerate without a c-section – my midwife had to turn me over to a doctor. Even then, he didn’t go straight for the knife. He proposed trying vacuum extraction, with a c-section as backup. Three tugs, three giant pushes, and three mighty shoves on the top of my uterus – out came the Bear.

I was grateful my son was healthy, and glad I’d avoided a cesarean. I thought I’d gotten off easy. The recovery proved me wrong. I’d lost a lot of blood and my healing was difficult and incomplete. In the long run, I probably would have been far better off with a c-section. The pushing on my uterus (“fundal pressure”) did a lot of damage to my pelvic floor, which persists a decade later. I was given a lengthy consent form that explained the risks of a potential c-section, but it said nothing about the risks of fundal pressure and vacuum extraction, particularly an extraction from so high in the pelvis.

In other words, I had no crack at informed consent for what was actually done to me. And I don’t want to hear that none of it matters since my baby was healthy. The violence of my delivery severely affected my ability to be an effective mother. Try hauling around a 13-pound infant six weeks postpartum, feeling as though your viscera are about to fall out. Then try it again with a 19-pounder at four months. The Bear was not a sleepy, contented baby. He was irked at the world. He needed to be walked around. I couldn’t do it. Not on the scale he demanded. For optimal healing, I shouldn’t have been lifting anything heavier than ten pounds. I felt utterly trapped.

Many women have traumatic childbirth stories. Many are uglier than mine and revolve around disrespect by medical personnel, which sometimes edges into outright violation. Over the past few years, some birth activists and feminists have started to label such stories “birth rape.” The term struck me as wrong when I first saw it (which I’m pretty sure was this post at the F Word). So I was glad to see a flurry of criticism ripple through the feminist blogosphere over the past few days, starting with Irin Carmon at Jezebel and then spreading to Amanda Marcotte at XX, Tracy Clark-Flory at Broadsheet, and Lindsay Beyerstein at Big Think. Even my friend figleaf has weighed in against using “rape” to characterize traumatic birth experiences.

In discussions of sexual violence, it’s not unusual for women who’ve actually experienced the trauma in question to use their experience as a trump card against anyone who disagrees with them. Ditto for childbirth experiences. In actuality, experiences vary, as do our interpretations of them. One woman may feel violated by a c-section, while another might feel relief.

So far, none of the feminist bloggers who’ve criticized “birth rape” have actually experienced childbirth in their own flesh. Their opponents may well say that this disqualifies them. I’m weighing in to support them, partly as a mother (and partly as a professional historian of childbirth and critic of medicalizaiton) who has in fact experienced a failure of informed consent and a traumatic birth (and who has studied some truly egregious instances of it in the past). Of course, my labor experiences don’t give me the right to trivialize other women’s feelings of violations, and I would never want to do that. At the same time, the trauma women experience doesn’t justify the inflationary and misleading use of “rape” to describe violations of medical consent.

It’s important that we can talk about birth trauma. We need a language of childbirth that will help us protect women’s autonomy. But it’s hyperbolic to call incidents of unwanted vaginal exams or artificial rupture of the membranes “rape.” It does an injustice to victims of actual rape by conflating two different phenomena, thus watering down the meaning of “rape.” It’s not as bad as the trivialization that goes along with saying, “Man, that test really raped me,” but both uses are on a continuum, because they’re both metaphorical, not literal.

I realize that proponents of the term say that a speculum is no different than a penis. Here’s how Amity Reed expressed it at the F Word:

A woman who is raped while giving birth does not experience the assault in a way that fits neatly within the typical definitions we hold true in civilised society. A penis is usually nowhere to be found in the story and the perpetrator may not even possess one. But fingers, hands, suction cups, forceps, needles and scissors… these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her. Women are slapped, told to shut up, stop making noise and a nuisance of themselves, that they deserve this, that they shouldn’t have opened their legs nine months ago if they didn’t want to open them now. They are threatened, intimidated and bullied into submitting to procedures they do not need and interventions they do not want. Some are physically restrained from moving, their legs held open or their stomachs pushed on.

These things happened commonly in the past, and they still occur today. A commenter at Salon wrote:

Once, while still a nursing student, I heard a nursing supervisor inform a screaming patient in labor – “maybe you should have yelled like that 9 months ago and you wouldnt be here”. Later, during my own labors, I remembered her remark and it made me smile.

She smiled? Boy, I’m glad she didn’t attend one of my births. And it gets worse. A self-identified midwife commented at Salon:

The quickest example I can come up with is the time a doula friend of mine heard the OB say while a VBAC mom was pushing (pretty much under his breath, I don’t even think the mom heard this): “It’s the LEAST you can do for your VBAC” and he put one end of the scissors in her vagina and one in her anus and cut her a 4th degree episiotomy. No fetal distress, no reason beyond what I guess was his irritation at not just doing a repeat cesarean?

(Her whole comment was terrific, if you can stand to wade through the morass of misogyny that is Salon’s comment section.)

Stories like these are appalling. I feel sick and angry when I read them.

And yet, this is not rape. There’s nothing sexual about it, even though the assault is perpetrated on a woman’s genitals.

Let’s take a look at the legal definition of “rape.” It requires, as Amanda Marcotte points out, intent to violate someone sexually against her will. This is what the law calls “mens rea,” or awareness that one is committing a crime. If a prosecutor fails to demonstrate mens rea in a rape case, it’s still possible to convict on a lesser count of sexual assault (e.g., gross sexual imposition). “Rape,” however, is off the table.

The intent of this OB was to hurry the birth along. I don’t think it’s a stretch to say that he was also high on his own power, getting off on his dominance. But he wasn’t getting off sexually. Nor was he intending to commit a sexual act. What he perpetrated was neither rape nor a lesser form of sexual assault.

“Birth rape” is not just an exaggeration, though. It also does not say enough. It fails to specify what makes such violations of autonomy in labor reprehensible in their own awful way. First, doctors and nurses enjoy a high degree of trust. The minority of them who break our trust deserve contempt. Similarly, the discourse on medical ethics has been hammering on the importance of informed consent for the past few decades. We rightly expect medical professionals to have internalized this. Most of all, a woman in labor is extremely vulnerable. I don’t know of any situation where I’ve felt comparably exposed, defenseless, and liminal. To receive abuse from the very person charged with expecting you and your child has got to leave emotional scars.

What should we call these violations, then, if not “rape”? Well, “medical battery” works for me. (“Medical assault” would be more satisfying because of the parallel to “sexual assault,” but legally the correct category, as far as I understand, is battery, not assault.) I would also distinguish between situations where real bodily harm is perpetrated, as opposed to assholish behavior such as slut-shaming women in labor, and also as opposed to neglect of informed consent, such as I experienced. (I’m not speaking here of outright malpractice, though some cases of abuse may also constitute malpractice too.)

Medical battery in childbirth ought to be treated as a criminal offense. That’s not a stretch, legally. For instance, except in an emergency, a physician who performs surgery against the patient’s will is guilty of battery, and is subject to both criminal and civil law. Even failure to obtain informed consent is already subject to criminal penalties. In cases of assholish behavior or flawed consent (as in my own experience), medical professionals should be sanctioned by their peers. In those cases where professionals protect their own and refuse to discipline offenders, patients should go public with their stories.

The law already supports a woman’s right to autonomy in labor, just like it does for any other patient. Actually enforcing that right in court is tricky. Doctors may argue that they were forced to act due to an emergency. Proving otherwise may be difficult. But just the awareness that medical battery carries penalties could work as a deterrent to battery and lesser forms of abuse. In addition, it might serve as a counterweight to the pressure OBs often feel to take action – any action, even if it’s not supported by evidence – to avoid a later malpractice suit.

To avoid failures of informed consent, obstetrical doctors and nurses could do much more to enlighten expectant mothers on possible interventions, their justifications, and their risks. I would have been better off if I’d been provided any information on the risks of vacuum extraction. I knew a lot about forceps because they were used in the period of history I study. Vacuum extractors are newer, and so I was flying blind, even though I was an exceptionally well-educated parturient. I didn’t even know that vacuum extraction carries a significant risk of damage to the baby’s brachial nerves. Most women would’ve known less. This is just not necessary in childbirth, where there’s usually nine months to prepare and become truly informed. And yet, neither doctors nor nurses nor midwives nor childbirth educators are really preparing the women whose bodies and children are at stake.

I don’t imagine that these potential solutions would be a panacea. I do think, though, that they’re closer to the mark than the tactics that a notion of “birth rape” would suggest.

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Wondering where I’ve been? Why, I just took a little trip to colonoscopyland. This is what I learned on my travels, presented for your edification and guidance:

My colon is free of all dread diseases. That’s a relief, because I’ve had weird digestion since I first got sick in January of 2009, and because my dad has lived with Crohn’s disease (which tends to run in families) for 50 years. So it seemed prudent to rule that out, even though I’m a bit younger than the average colonoscopy customer. Requests for pictures have already been pouring in. Sadly, I can’t oblige with the DVD. (Sorry, Hydraargyrum.) But I will say that I saw a few still photos while I was coming out of the sedation, and they looked much like the Caves of Altamira – minus the artwork.

Photo via Wikimedia Commons

If you must travel in my footsteps: Expect a two-day journey. The prep will kill the better part of day one. At first, I was able to do a little computer work, but so intermittently that I think I may have wrecked one of my Blackboard classes for lack of focus. The second day is divided between final prep (if your appointment is in the afternoon, like mine) and then, once the deed is done, feeling stoned from the sedation.

I know a lot of people worry about colonoscopies because of their feeling toward The Butt. I am here to tell you: Forget about The Butt. Apart from having to don one of those flapping-in-the-wind gowns, I had no conscious interactions with anyone regarding The Butt. All Butt-related activities take place under heavy sedation.

The prep is the worst segment of the journey, partly because of the sheer volume, which I badly misunderestimated. A gallon is not 64 ounces as I’d thought; it’s 128! Oh why are we not on the metric system? The other nasty part was its fetid taste. I’m glad I didn’t come up with the descriptor “fetid” while in the fray, or I might have given up altogether. After really gagging on the first of the 16+ glasses, I figured out a good system: Make sure the liquid is very cold. Take a breath and hold it. Use a straw and suck as furiously as you can. By the time your tastebuds notice how gagworthy this stuff is, they’ll be half frozen and you’ll be able to get the rest down. Then, chase it with a little apple juice, which will also help you keep hydrated. Worked for me.

If you consume green jello – one of the approved “clear liquids” – during the prep, expect to see green the next morning. I woke up, finished my prep, then thought I’d suddenly developed a truly dire condition. It was worth the shock, though, because the jello wasn’t plain old boring American lime; it was German Waldmeister jello.

(You will spend a fair amount of time scrutinizing the contents of your toilet bowl. Get used to it.)

The objective at the end of the prep is to be emitting the sparkly excretions of a unicorn, or at least of My Little Pony.

Photo by Flickr user dreamcicle 19772003, used (and lighted cropped) under a Creative Commons license. She has a lot more like this one, all zany, creative, and great fun.

This objective will founder if you naively (but joyfully!) consumed a pound or two of tomatoes the day before your prep. Pay no heed to the allure of the Purple Calabash and the Brandywine!

Their seeds will continue to present themselves for inspection at the point where you really ought to be seeing nothing but rainbows, sparkles, butterflies, and violets. And as you stare into the bowl, you can only see the spectre of COLONOSCOPY FAIL – and facing a redo, after all this fuss and fiddling, just because some tomato seeds mistook your viscera for a nice place to live until germination.

Once you’re surrounded by kind helpers, ask for lots of hot blankets, and let the kindest-looking nurse know that you’d love a little something just to “take off the edge” while you wait. Hey, you’re not driving this train, you’re only the caboose! So why shouldn’t you party it up? Alternatively: Just be like me and get red blotches on your neck whenever you’re nervous or psyched up, and maybe the nurse will offer you some Versed. Worked for me. Next time, I’ll be sure to have some Grateful Dead cued up so I can fully savor the buzz.

The moment between the sedative entering your vein and bearing you off to colono-lalaland is absolutely fascinating. You can feel your consciousness bend. I wanted to freeze that brief moment – to have that experience in slow-mo, again with Jerry laying down the soundtrack. The drug in question is Propofol. It’s what killed Michael Jackson (in combo with Ativan). Now I know why Jackson died. I also know why I will never experience more than a fleeting second in that state. It is too dangerous. Too seductive.

Afterward, expect to remember nothing of The Butt. If you do, either someone screwed up, or you’re in the evil hands of Dr. de Sade. This is why you need to figure out the doc’s approach to sedation before you commit yourself into his hands.

In recovery, I drank a Diet Pepsi to mellow out my caffeine withdrawal; only too late did I hear that the dude next to me got a Mountain Dew. But he had a polyp and I did not. Also, in the competition to pass gas (required before discharge), he was trouncing me. That quenched my envy. I was still jonesing for some Jerry, because even though I was clearheaded, I was also still tripping.

Now, ten hours later, I’m still loopy enough to write a TMI post like this one (cleverly disguised as a PSA!). My legs are still a bit wobbly – a late effect of overdosing on Waldmeister jello? I’ve got a mild headache; a hangover, I presume, from the Propofol and general dehydration. But I’m told I should feel fine in the morning.

If anyone stumbles upon this post while gearing up for your own trip to colonoscopyland: Bon voyage! As y’all know, it’s not just a trip – it’s a pilgrimage for the over-fifty set, which calls you once a decade. Early diagnosis likely saved my mom from developing colon cancer. I strongly recommend you take the journey, too. Just remember to leave the tomatoes behind … lest they never leave your behind.

P.S. Feel free to share TMI, fears, and potty humor in comments … or if you’re just irredeemably squicked, you may sing “lalalalalal” and hold out for another cat post, which I promise is coming soon. (Just remember, though: Cats have butts, too! And they are quite inimical to sparkle ponies.)

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Actually, this isn’t a truly new option, just one that has gotten no press up to now: using an IUD for emergency birth control:

A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.

The device – called Copper T380A, or Copper T – continued to be effective at preventing pregnancy a year after it was inserted.

“It is by far the best emergency contraceptive option,” Dr. James Trussell, who studies birth control methods at Princeton University but was not involved with the current study, told Reuters Health of the device. “But many people just don’t know about it.”

Copper T, marketed as ParaGard in the United States, is a T-shaped piece of flexible plastic wrapped in a layer of copper that is inserted into the uterus. It works by stopping sperm from reaching the egg and by preventing an embryo from implanting in the wall of the uterus.

Led by Dr. Shangchun Wu at the National Research Institute for Family Planning in Beijing, China, the authors followed almost 2000 Chinese women who were implanted with the Copper T after coming into family planning clinics for emergency contraception. All of the women had engaged in unprotected sex in the previous 5 days.

(Read more at Reuters.)

Now, I have to admit I’m one of those women who remembers the publicity around the Dalkon Shield, including the subsequent lawsuits, and so I’ve never really warmed up to the idea of an IUD. But that’s just an emotional reaction. The safety record of the Copper T is very solid. Its effectiveness in the follow-up year of this study was similar to the overall track record of the IUD, with fewer than 1% of women becoming pregnant. (A few of them didn’t tolerate the IUD; either they expelled the IUD or had it removed due to side effects.)

The Reuters article also lays out the barriers to using an IUD as EC. You need to make an appointment with your gyno, and that may not be do-able within five days. The upfront cost ($500) is daunting if insurance won’t cover it.

One point that the otherwise thorough Reuters report missed: A few doctors still suffer under the misapprehension that inserting an IUD is too difficult in woman who’s never borne a child; it’s not, though it may sometimes be a bit trickier. This is a declining problem, but it’s still been an issue for some women (according to the commentariat at Feministe).

Despite these pitfalls, I can imagine the IUD being an excellent choice for many women who need EC. If you’re someone whose birth control is iffy because you have a hard time remembering to take the Pill, the IUD will solve that problem. If you only use condoms sporadically and therefore need EC, the IUD might be a good solution.

Especially for anyone who’s a repeat customer for EC, the IUD seems like a highly sensible choice. While IUD insertion can cause cramping (which can persist for a few days), Plan B can inflict pretty intense nausea. Having to chase down EC repeatedly is stressful for body and soul. Where 1 in 100 women will still get pregnant on Plan B, it’s fewer than 1 in 1000 with the IUD as EC. And in the long run, a woman who chooses the IUD is highly unlikely to face an unwanted pregnancy.

That’s not a panacea. But it’s a pretty excellent option.

Update 8/9/10, 10:30 p.m.: MomTFH, who (unlike your humble hostess) has actual medical training, added a whole ‘nother dimension to this in comments. Click here to read her whole contribution. A few highlights: “I was actually told by my ob/gyn that I wasn’t a good candidate, even though I had already had a baby, because I was divorced. (!!)

“According to a midwife who taught me about birth control, the reason why IUDs were not recommended for nulliarous women were because so many of them successfully sued over the Dalkon shield. The company had to pay a much higher settlement to women who never got to have children due to their injuries than they did to those who already had children. The indications for the newer IUDs, including the copper T, originally said the ideal candidates were parous women, but that is no longer the case. New recommendations say that pretty much any woman who does not have active pelvic inflammatory disease is a good candidate.”

She notes that the standard of care in the U.S. is to screen for STIs before insertion of an IUD, which would add to the difficulty of using an IUD for EC. I have to wonder if one reason for some practitioners’ coolness toward the IUD is that they worry women won’t take precautions against STIs, yet they also won’t need to come in for an annual exam (as they would if prescribed the Pill, patch, or shot) where an STI could be diagnosed and treated.

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Sooner or later, most parents end up in the ER with their offspring. And if you’re a frequent customer, chances are pretty good you’ve bumped up against the increasingly ubiquitous CT scan (aka “catscan”).

Our Tiger has racked up more than his share of visits, including one when he was three when he ran a fever over 104 F and complained of a terrible tummy ache. At our local hospital, the doctors ordered an abdominal x-ray, which indicated a dramatic case of … constipation. But since his fever was high and appendicitis couldn’t be ruled out, we were sent up to Children’s Hospital in Columbus. There, the resident on duty wanted to do a CT scan as soon as possible.

“Can you really diagnose appendicitis with a catscan?” my husband asked.

“Well, no.”

“Could we talk to your attending about this?”

The resident’s boss agreed that there wouldn’t be much point to a CT scan. They didn’t want to release us, though, because if we went home we’d be an hour and a half away. And so the attending took a truly radical step: she admitted us. We spent a short and restless night with the Tiger, his dad sharing the bed with him, me scrunched into a recliner. (The Bear stayed with friends who generously took him in at short notice.)

In the morning, the Tiger pooped. He felt better. His fever was dropping. We were sent home that afternoon. A few days later, bloodwork came back with signs of a bacterial infection in his blood (a strain of pneumococcus not covered by the vaccine). He got antibiotics and never had another unexplained high fever again. To this day, his appendix is just fine.

Most parents probably wouldn’t have resisted the resident’s suggestion. Heck, if I’d been alone, I wouldn’t have questioned it, even though I’m usually quick to ask. When you’re scared and alone with a sick child in the middle of the night, it’s hard to challenge authority. It was only my husband who had enough presence of mind to weigh the long-term danger of radiation. The resident’s only concern was not to miss something – anything – that modern medicine might ascertain. Long before young doctors learn all they need to be expert diagnosticians, they learn not to discharge a patient until everything possible has been done, no matter how pointless, expensive, and possibly hazardous. This is classic defensive medicine, driven more by fear of lawsuits than by the patient’s optimal treatment.

Don’t get me wrong. CTs are a great tool. They are just overused, whether out of technophilia or fear or liability, or both. And the New England Journal of Medicine notes in its July 1, 2010 edition that the use of CTs is underregulated. Rebecca Smith-Bindman’s article, “Is Computed Tomography Safe,” was initially available as a free full text, but it has disappeared (here’s a .pdf of the onscreen free version that I’m using as reference). Essentially, Smith-Bindman argues: 1) Hospitals somewhat rarely but regularly make devastating errors when CT equipment is improperly monitored, which sometimes results in severe accidents. 2) There are no clear guidelines stating when a conventional CT versus a more precise CT (with greater radiation exposure) would be appropriate. 3) There are no guidelines in place for minimizing radiation exposure, period. 4) The FDA approves technology and devices but it doesn’t oversee the actual usage of equipment. 5) Unnecessary radiation from the ostensibly “safe” CT can kill:

We [Smith-Bindman and colleagues] found that the risk of cancer from a single CT scan could be as high as 1 in 80 — unacceptably high, given the capacity to reduce these doses.

The NEJM article neglects any discussion of children, but the literature to date has raised even bigger red flags about pediatric uses of the CT scan. This is only logical. Kids’ bodies are smaller. They are still growing, so damaged DNA will have many more opportunities to go rogue. They have many years ahead of them – or so we hope – such that rogue cells have many decades to exact their revenge. A 2008 article in Time magazine puts the risk of a fatal cancer from a single pediatric CT scan at 1 in 500, and vividly illustrates why parents should be skeptical:

When doctors first ordered a CT scan for Jen Houck’s six-month-old daughter in 2003, the new mom was more worried about the risks of anesthesia (used to keep children from squirming in the machine) than of radiation exposure. In 2006 and 2007, her daughter, now 5, had two additional CT scans, 6 months apart, for what doctors initially thought was a growth abnormality. They’ve since determined the child was perfectly healthy. “All that, just to find out her head is bigger than normal,” says the 27-year-old mother of two in Boone, North Carolina. In hindsight, Houck wishes she had done things a bit differently. “I would have asked more questions about the necessity for a third scan so soon after the second.” She also says no one mentioned the option of a low-dose scan, and she has no idea how much radiation her daughter received. “I wish I’d known to ask the question.”

(It’s a good article – read the rest here.)

So today’s Caturday post is a bit of a PSA, or at least a cautionary tale (tail?): Don’t be afraid to question the risks versus benefits of a proposed CT scan. Even if it’s your kid’s health at stake. Especially if it’s your kid’s health.

(from ICHC?)

Editorial note from the patron cat of Kittywampus: Grey Kitty would have approved of the simpler, lower-energy greyscale catscan. Nice tail, too – very similar to GK’s own.

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And I might have become one myself, had I not blown up some chemicals in a high school lab. (My best-friend-cum-lab-partner took that incident as a signal from teh Ceiling Cat to pursue a Ph. D. in microbiology, so go figger.) Throughout college, at least half my friends were in STEM fields, maybe because Stanford was so heavy on engineers. (Conspicuously few were premeds, though, as playing in the Band had a lethal impact on many folks’ GPA.)

I still really enjoy science – and scientists – and so even if there were no gender angle to it, I’d still get a kick out of this website, which features drawings of scientists done by seventh graders. Each has a before-and-after version, with the “after” drawn once the student had met up with a real, live specimen of a scientist at Fermilab.

The paired drawings handily expose all manner of stereotypes – and the students’ growth beyond them. Sometimes it’s terminal nerd-dom that gets swept away, as in these sketches by “Ashley“:

Not that nerdiness need be bad, mind you!  Disclaimer: I too cherish my inner nerd. Though I never really took to Heinlein, I still have a soft spot for the original Start Trek, and some days I like books a bit better than people. And I’m willing to bet that I’m not alone – that most humanities types harbor a little nerdy streak, though we try with varying success to cover it up. The most assertively hip and fashionable big academic shindig, the MLA conference, might be interpreted as a massive exorcism of the inner nerd. Surely there’s a paper in that: “The Return of the Repressed: Post-Freudian Perspectives on the Nerd Within.”

While Ashley’s drawing makes mention of women and men, some of the other girls actually shifted the gender of their “typical” scientist. A great example comes from Amy:

See, the scientist shifts from being obsessive and frankly unbalanced to … being hip circa 1972! A scientist may even be interested in racquetball! (And honey, I’m not snarking about the “even” – I had zero interest in the sport.)

And a scientist can be a gal. A fashionable gal, even, who’s friendly and open and has a sense of humor. A gal who likes to dance.

Now, go flip through the other drawings. They’re cute, they’re enlightening, and they show that Amy was not alone in her preconceptions, even if she did draw the awesomest green smoke.

So the next time someone starts spouting untested, Lawrence Sommer-esqeu theories about women being naturally less suited than men to STEM careers, we might recall Amy’s sketches. We might ask what happens when girls (and boys!) meet real-life scientiests. We might also ask how to make science careers more family friendly – but oy, that’s be a whole ‘nother post. We might wonder how we can offer encouragement to those girls who nearly blow out a ceiling tile in chem lab (ahem!).

In the meantime, I have a couple of scientist friends who I think would rock that turquoise blouse and matching oversized shades.

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This post doesn’t get a trigger warning, exactly – just a sticker for minor TMI and, well, a bit of ickiness.

Yesterday Hitler went into his bunker one more time. By the time my lecture ended at 2 p.m., he had died again – and not a moment too soon. While we’ve still got another week of classes, I must say it’s a mighty relief to know that Hitler is now charred beyond recognition. For all the satisfactions I’ve found in teaching this course, it has been emotionally and intellectually arduous. (And of course, my own struggles are a trifle, compared with those who were actually, historically victimized by the Third Reich.)

But this is not a post about Hitler. Indeed, now that Hitler is out of the picture – and just in time for the three-day weekend, too! – I finally feel free to take some time to sticky-tack my own life back together. For instance? Long-deferred trips to the doctor, including my first-ever visit to the dermatologist. If you’ve checked out my little Sungold pic, it’s obvious that surveillance for skin cancer ought to have started with me still in the womb. And indeed, the doc agreed that two of the spots I’d identified as potential trouble were precisely that. Out came the portable deep freeze, which spritzed all points of suspicion with liquid nitrogen. Those trouble spots now look far worse than ever, but I’ve been assured that any rogue cells have been killed dead, and that the dark-brown spots will eventually fade, rather than being the first step toward dressing as a Sexy Dalmatian next Halloween.

But then there was a third spot, not nearly so suspicious, but quite uncomfortable whenever I leaned back against a hard wooden chair. My doc said no problem, we can remove that mole, too. This trick, however, required a signed consent form, a shot of lidocaine, and a few stitches.

Afterward, I asked to see the “specimen,” now floating in a jar, which would be sent to pathology. It looked remarkably like a very pale pencil eraser. It look like a pencil eraser had mated with a fetal pig preserved in formaldehyde. Yes, I do see the biological implausibility of this. I’m going for the aesthetic point while realizing that this is – at best – the opposite of aesthetic.

I am not grossed out by things floating in glass jars. For that, I spent far too much time reading historical medical journals while working on my dissertation. I was just fascinated at how this plug of tissue, barely reddened and fringe-y where it had moments earlier nestled near my spine, had gone within seconds from being me to not-me.

All of which brought me back to a theme that has preoccupied me ever since, some weeks ago, I was looking through some college-era pictures. Those quarter-century old pictures were also, emphatically, me/not-me, though mostly on a symbolic level.

Nestled among the photos was an old braid of hair. My hair. It wasn’t a mere representation. This braid? It was physically me. I had grown it, brushed it, more or less tenderly cared for it. And then one day, soon after I met my someday-husband, I needed lightness, and so off went my locks. (This was before anyone was aware of Locks of Love. From today’s vantage point, I suspect my braid is too short to donate. Anyway, the vintage of my braid (1992!) hardly makes me a fab donor candidate.)

This braid is still tangible. You can pick it up and stroke it, marveling at how much softer my hair was in my youth, back when I rarely blowdried it and never colored it.

It is a piece of my youth, transported, whole and unfaded, into my increasingly middle-aged present.

Mostly, though, I almost feel as though this disembodied piece of me should be able to bear witness. It cannot, of course. But it should, dammit! Nothing else in my life has stayed inert since 1992. I’ve married, borne two children, moved from Germany back to the U.S., bought a house, finished a dissertation, embarked on a teaching career, seen my husband through two forms of cancer, and learned to like horseradish.

I think similar thoughts about my kids’ teeth as they lose them. I have no dignified way to keep them. They pile up in plastic ziplocs like tiny pawns for a game as yet to be determined. These little gamepieces are both of my children and yet wholly other. I do not know why I keep them. I couldn’t bear to thrown the in the trash. They’d require a solemn burial.

I guess there are two aspects of our permeable, detachable, deconstructable bodies that perturb me.

One is that these lost teeth remind me of aging, and I don’t just mean my own. As he approaches his seventh birthday, the Tiger now has only half of his top teeth. When his permanent teech ease into place, his little-boy grin will be gone forever. Actually, it already is. When that little boy is gone, he’s gone for good. He’s essentially dead, apart from those fragments of memory we carry with us. They are never enough.

The other thing? All these loose part – these spare parts – remind me that it’s not just the body that’s permeable. Our selves are permeable and unstable. Call me a postmodernist, but I think this is both true, and deeply unsettling.

Or maybe I’m just my mother’s daughter. For years after her gallbladder removal, she kept a vial of her stones in the medicine cabinet. I’m guessing they’re still there.

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So Sue Lowden – the Republican challenger to Harry Reid – is waxing nostalgic for the days when we could barter for health care, instead of having to mess with all that expensive, bureaucratic health insurance. Here’s the money quote (or the bartered-chicken quote?) at Big Think:

“You know, before we all started having health care,” she recently said in an interview, “in the olden days our grandparents, they would bring a chicken to the doctor, they would say I’ll paint your house. I mean, that’s the old days of what people would do to get health care with your doctors. Doctors are very sympathetic people. I’m not backing down from that system.”

Badtux suggests paying Lowden in chickens, should she become the next senator from Nevada. What an excellent idea! She can run her budget like my paternal grandfather did.

My grandpa was one of those country doctors who did accept payment in kind. Born in 1879, he earned his M.D. from the University of Nebraska in 1907, one of a graduating class of 18 (including one woman). He wound up practicing in North Dakota – whether for humanitarian reasons or due to a love affair gone bad, we’ll likely never know – in a poor part of the state populated mostly by German-Russians. These folks were originally from southwest Germany, where inheritance patterns split landholdings into ever smaller, less sustainable parcels. They migrated to the Crimea in search of an easier life, and thence to North Dakota. I know, I know – they must have had a very flexible notion of the “easy life.”

Once tucked into their large but chilly homesteads, the German-Russians stayed. Where else would they go? They were still poor, for the most part. And they continued to catch smallpox, measles, cancer, and the occasional pregnancy.

My grandpa was the doctor for much of south-central North Dakota. There were a few midwives in the area, too, but over time he attended more of the births.

And yes, sometimes his patients paid him in chickens. My mom describes him thus:

He had a gruff exterior and a very soft heart. I know that the people in Streeter idolized him (some may have feared him a little), and nearly everyone could tell of a time that he came to their farm in the middle of the night and dstayed until the patient was out of danger and usually refused to take any payment, especially if they were poor.

There were days when a chicken was more than a family could spare.

At the end of his life, the town’s very modest public park was devoted to his memory. I like knowing it’s there, even if the play equipment is decrepit. I never knew him; he died in 1961, two years before I was born. It’s a lovely testimonial to his putting patients above profits, which really does seem quaint and almost saintly in the new millennium.

But here’s the trick. My grandpa could afford to work for chickens – or eggs – or even a big old goose egg only because he also had patients who paid him! What’s more, he had much more substantial savings than his neighbors, having invested in Standard Oil around 1900. He and my grandma lived modestly, despite her pretensions to being the town’s aristocracy. (Well, the town was small enough that she sort of was the queen bee.)

My grandma fought with my grandpa over his generosity. He saw the grinding need up close. She saw it at a remove, and only through the lens of a trying to maintain a reasonably bourgeois household on the prairie. They fought bitterly anyway, and the chickens (and all the other bartered goods) became just one more bone of contention.

My grandpa did quite a lot of good, I believe. But it was no way to run a practice, and even less so today, when new doctors may start out burdened with six-figure debts. It also was no way to nurture a marriage. The whole thing was unsustainable, even then. Add in an MRI and a CT and an angiogram … and my grandpa could never have worked for free.

I suspect, though, that he would have been fascinated by the new technologies. He was smart and curious – qualities solely need in the practice of medicine as well as in the debates over its reform.

Frankly, though? As much as I like chickens, I don’t see much of a place for them in Washington. We’re gonna need tougher critters than chickens to fix our broken health system. Unless, perhaps, they’re as fierce as this guy looks – yet not bird-brained.

“Black Rock chicken” from flickr user Todd434, used under a Creative Commons license.

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