Saturday, June 30, 2007

Skipping Your Period, The International Edition

Studies suggest you have a greater tolerance for long intervals of skipping your period if you're a woman residing in Western Europe rather than in Asia or Africa.

Prefer never to have a period

Netherlands, Germany and Scotland - over 35%

Hong Kong, Nigeria and Shanghai - 6%, 13% and 15%

South Africa - 29% (white), 9% (black)

From a social survey of 1207 healthy women from Campinas (Brazil), Heidelberg (Germany) and Ann Arbor (USA) (~400 women from each country):

Prefer never to have a period

- one-third of USA and Brazilian women [about 38% and 33%, respectively]

- less than 10% of German women

Prefer to have a monthly period

- 15% of USA women

- 25% of Brazilian women

- 30% of German women

Prefer to have a period every six months

- ~ 15% of women in all three countries

In response to the question “if you could change the way you menstruate, what single change would be most valuable to you?”, half of all German women and one-third of USA women listed “having more precise control over the timing of menses” as their highest priority. “Having less pain” was the highest priority for a quarter of Brazilian women.

German women, on average, mentioned three times more positive features of menstruation compared to USA or Brazilian women.

Most positive features of menstruation

- being assured of not being pregnant; feeling healthier; and feeling lighter.

Most common negative features of menstruation (across all three countries)

- inconvenience; cramps; bad mood and premenstrual syndrome.

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NuvaRing Acceptability

Willingness to use NuvaRing, from a survey of 691 female college students:

OCPs were the most popular method, with more than 86% of respondents indicating that they were willing to use (53.5%) or were already using (32.8%) OCPs, followed by almost 40% who were willing to use the contraceptive patch. Respondents were least likely to be willing to try the contraceptive vaginal ring (20.4%). Respondents were primarily concerned with pregnancy and STD protection, cost, accessibility and side effects.


A very interesting finding from the survey:

Respondents expressed a twofold preference for oral administration over skin administration, threefold preference for oral administration over injection and more than eightfold preference for oral administration over vaginal administration. However, respondents expressed a strong preference for less frequent administration: more than 60% stated that they liked weekly or monthly administration, compared with 43% who preferred a daily method.


The researchers conclude:

[This study] highlights the importance of considering social context in the development of contraceptive methods and reinforces the need to obtain women's feedback on characteristics of the method in acceptability studies. Indeed, despite the desirable dosing schedule, the monthly regimen alone may be insufficient in motivating young women to use a method that entails vaginal insertion, particularly committed oral contraceptive users. Thus, clinicians should emphasize ways of increasing the acceptability of contraceptive vaginal ring insertion. These might include clinician insertion during the office visit, counseling regarding the ease of self-insertion and suggesting insertion devices such as tampon holders. These measures may increase the acceptability of the contraceptive vaginal ring among young women with busy lifestyles who might benefit from a nondaily method.

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Birth Control and Emergency Contraception In Oregon

Oregon politicians decide women should be able to receive adequate medical care:

With Gov. Ted Kulongoski's signature on a new piece of legislation, Oregon joined more than 20 other states in requiring coverage for contraceptives by employee health insurance plans. The new law, which will go into effect Jan. 1, 2008, exempts certain religious employers from the requirement. The law also requires hospitals to inform victims of sexual assault about the availability of emergency contraception and requires hospital staff to provide it upon request. “This fight is fundamentally about women being able to make the best health care decisions for themselves and their families,” Gov. Kulongosk, a Democrat, said in a statement. “With the signing of this bill into law, we continue our ongoing work to expand personal freedom and offer women full equality in our society.”



Good for Oregon, and a step in the right direction. Now, how long until politicians realize that, just because the patients are female, they have no business legislating patients' health care decisions?

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Friday, June 29, 2007

Childbirth-Related Costs For Teenagers

Cost of childbirth-related hospitalizations of girls younger than 18 years:

$464,157,600

Who pays for these hospitalizations:

Medicaid - 75%

Private Insurance - 20%

No insurance - 3%

Other - 2%

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The Google Health Advisory Council

The business plan behind the new Google Health Advisory Council:

Step 1: [A]nnoy the docs, nurses, and medlibs right away

Step 2: ?

Step 3: Profit

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Wednesday, June 27, 2007

Your Doctor Owns You

If you're a female patient of reproductive age and you hope to receive adequate care, that is.

Allow me to illustrate.

Patient #1

Breech presentation [feet first]; to convert to vertex [head first], in order to avoid a C/S and attempt a vaginal delivery, an external cephalic version is indicated.

"Doctor, I'd like to try a vaginal delivery ," the patient tells me. "No," I reply. "I can't do that. It's against my religion."

I can get away with refusing to provide adequate care because, for female patients of reproductive age, the applicable standard of care is What You Feel In Your Heart (TM)*. If you feel in your heart an action would cause harm to somebody—born or unborn—it's legitimate to decline to participate [in rendering proper care].

*[As I'm sure you're aware, What You Feel In Your Heart (TM) is not just a basic medical principle. It's also a fundamental legal principle. One recognized and respected by malpractice attorneys and juries everywhere.]

Also, keep in mind that any patient encounter is, ultimately, all about me, the physician. It's about my rights as an individual, about my constitutional right to freedom of religion. I'm not trying to deny anybody access to treatment. I'm saying, "Don't bother me with your silly medical concerns. Don't make your choice my choice."

Patient #2

Asks for some pain relief during labor. That's when I inform her that I'm a Scientologist and that pain relief for pregnant women is against my religion. Five minutes of verbal sparring later ['cause what would providing medical care be without the patient having to beg and plead for it just a tad], I relent with an order for pain meds—but only after the patient tells me she needs pain control for a toothache, not to ease labor.

"This is about the rights of the individual, about our constitutional right to freedom of religion," says Frank Manion, an attorney with the American Center for Law and Justice, a legal group in Washington, D.C. Founded by minister Pat Robertson....

I told you so! Patient encounters involving female patients of reproductive age are not about medicine and rendering care. They're about the doctor's rights as an individual and, of course, religion.

Patient #3

Comes in for a routine physical. "So, your husband is in agreement with your decision to come in today on your own, unaccompanied?"

"I'm not married," the patient tells me.

"You're not?" I calmly put down my pen. "Then I'm not comfortable continuing this exam."

Later, I explain that "My decision to not perform a routine physical and to refer the patient was not because she was unmarried; rather, it was based on my moral belief that a woman should not be allowed in public unaccompanied by a husband or a male relative." I add "Such religious beliefs are a fundamental right guaranteed by the Constitution of the United States."

In the end, all the women I mentioned were able to get the treatment they wanted, even if they had to go elsewhere. So one could see my refusal to render adequate medical care as a mere inconvenience. "In 99.9 percent of these cases, the patients walk away with what they came for, and everyone's satisfied," Manion asserts. "I know there's the horror story of the lonely person in the middle of nowhere who meets one of my clients. But those cases are so rare."

Mr. Manion couldn't be more right if a Sky Fairy lodged itself in his ear canal and told him what to say.

That is, he's right when you consider that the standard isn't the patient receiving appropriate medical care, but rather her receiving care at some point, somewhere, somehow, by somebody, fingers crossed she has adequate resources and know-how to arrange for alternate care, and pray to [insert deity of choice here] she's part of an imaginary 99.9 percent of cases who do manage to get proper medical care.

Now if this standard doesn't fill you, the patient and your loved ones, with satisfaction, I don't know what will.

But wait; there's more!

If there's one thing both sides can agree on, it's this: In an emergency, doctors need to put aside personal beliefs to do what's best for the patient. But in a world guided by religious directives, even this can be a slippery proposition.

"I was told I could not admit her [14 weeks pregnant with ruptured membranes] unless there was a risk to her life," Dr. Goldner remembers. "They [the nearby Catholic Medical Center] said, 'Why don't you wait until she has an infection or she gets a fever?' They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy."

Turns out, the definition of emergency depends on whom you ask. Dr. Christiansen, the pro-life ob/gyn, says she would not object to either method [medical or surgical] of ending an ectopic pregnancy. "I do feel that the one indication for abortion is to save the mother's life—that's clear in my mind," she says. "But the reality is, the vast majority of abortions are elective. There are very, very few instances where the mother's life is truly in jeopardy."


I dare you to challenge Dr. Christiansen's statement. Let me save you some time; you cannot.

As long as it's acceptable in this country to debate and set policy based on the premise that, if a patient is female, she may only receive care if, and only if, her life is in danger, you don't have a leg to stand on [chances are, quite literally if you're female and your condition isn't deemed life threating enough to operate and save said leg].

As things stand now, the Drs. Christiansen of the world, your neighbors, politicians, and complete strangers get to decide how close to the brink of death you may be permitted to get, before you're allowed to receive adequate medical care.

So, to sum up, if you're a female patient of reproductive age:

1. Medical decision: Based on what your doctor feels in his/her heart, not science.

2. Doctor's visit: Not about you and your medical problem; rather, about religion. [The doctor's, of course, you silly goose.]

3. Treatment: It's not about receiving adequate medical care. It's about receiving something, at some point, somehow, somewhere. [Kinda like magic, really. Do-it-yourself magic.]

4. Indication for treatment: If, and only if, your life is in danger.

Here's.To.Your.Health!

UPDATE: #1 Dinosaur has more.

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Emergency Contraception In Brazil

SAO PAULO, Brazil - Brazil's government has added "morning after" pills to its newly expanded birth control program in hopes of helping poor people reduce unwanted pregnancies and dangerous illegal abortions.

Health Minister Jose Gomes Temporao announced the addition a month after President Luiz Inacio Lula da Silva said the government would provide cheap birth control pills at 10,000 drug stores across Latin America's biggest country.

Speaking at a round-table discussion Monday sponsored by the Folha de S. Paulo newspaper, Temporao called the morning-after pill "an important tool for the prevention of unwanted pregnancies that will definitely be part of our strategy" to help Brazil's poor have the same access to birth control as its rich elite.

...

The newly expanded program offers regular contraceptives at commercial drug stores for sale at just $2.40 for a year's supply. Temporao didn't say whether the morning-after pills would be subsidized or entirely free. Previously, the government said it would distribute 50 million packages of regular birth control pills, each with a month's supply, by year's end.

...

Ana Lucia Cavalcanti, who heads women's programs for Sao Paulo, knew of no other Latin American nations that supply free or subsidized morning-after pills. She called on the government to launch education programs so poor women understand how to use them.

...

Temporao also has lobbied for a national referendum to legalize abortion up to the 12th week of pregnancy. Brazil now allows abortions only when women have been raped or their lives are in danger, and polls show Brazilians overwhelmingly oppose changes.

Women's rights groups estimate 800,000 illegal abortions happen in Brazil each year, and about 4,000 women die from the back-office procedures annually. Abortions are the fourth leading cause of maternal death in Brazil after hypertension, hemorrhages and infections.

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Monday, June 25, 2007

Vaginal Tears and Delivery

Very nice drawings of vaginal tears from the Mayo Clinic (Warning: graphic).

vaginal tear

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Saturday, June 23, 2007

How to Persuade [Some Female] People to Give Up Their Vulgar Ways In 4 Easy Steps

Step 1: Appoint yourself in charge of their life.

Step 2: Decide that what they do is icky and mustn't be tolerated.

Step 3: Arrive in the middle of the night to raid their house in a residential neighborhood, abduct them, and hold them against their will for ~17 hours.

Step 4: Forcibly clad them in black, all-enveloping burqas, and only release them after it becomes clear you might've upset the Big Boys.

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Tuesday, June 19, 2007

Extended Pill Regimens

The good and the bad:

Good. Effective long-term treatment for hormone withdrawal symptoms, such as headaches, pelvic pain and mood swings, that occur on 21/7 regimens. [The symptoms respond relatively quickly to an extended regimen with maximal improvement usually seen within the first few weeks with persistent long-term improvement.]

Bad. Breakthrough bleeding/spotting (BTB/BTS) can be a problem for some patients.

Note the BTB/BTS remedy:

[If] BTB/BTS is problematic, improvement continues as the duration of extended use lengthens with institution of a 3-day HFI* [hormone-free interval] effective management in the majority.

*In other words, if you're on an extended regimen and you experience BTB/BTS, stop taking the Pill for 3 days, then restart (after consulting with your Ob/Gyn, of course).

NuvaRing vs. the Pill

Nuvaring has the same contraceptive efficacy as the Pill with lower systemic estrogen exposure, more consistent serum estrogen levels and better cycle control, but more local adverse events resulting in higher discontinuation rates.*

A review of twelve randomized controlled trials comparing the combined contraceptive vaginal ring (NuvaRing) and the [30-μg] combined oral contraceptive pill (Pill) found that:

1. Systemic exposure to estrogen with NuvaRing was approximately 50% of that for the Pill (15 μg EE per day vs. 30 μg EE per pill).

(Unfortunately, the influence of the lower EE exposure with the [NuvaRing] on lipid metabolism and coagulation factors remains unknown, as no RCTs between [NuvaRing] and the [Pill] on these important metabolic parameters have yet been published.)

2. Despite the lower systemic exposure to EE, the incidence of estrogen-related adverse events such as breast tenderness, headache and nausea was not significantly different between both treatment modalities.

3. No apparent differences between both methods were found in blood pressure changes, body weight changes or decreasing rates of PMS and dysmenorrhea [pain] complaints.

4. Contraceptive efficacy during the first year of use was excellent and comparable between NuvaRing and the Pill. (This finding should be interpreted with caution, of course, as it is not predictive of the long-term contraceptive results.)

5. Better cycle control with NuvaRing than with the Pill.

6. The vaginal route of hormone administration was associated with higher incidences of local adverse events such as leukorrhea [discharge], vaginal discomfort, vaginitis and ring-related events comprising foreign body sensation, coital problems and expulsions than the oral route.

7. Discontinuation rates due to local and ring-related adverse events were higher in the NuvaRing groups than in the Pill groups.

8. Incidences of serious adverse events were low and comparable in both groups. (However, the number of participants in the studies was too small and the duration of the studies too short to provide any reliable information on the incidence of infrequent but serious adverse events like thromboembolism.)

9. Both NuvaRing and the Pill were found to be highly acceptable methods of contraception.

10. Compared with women not using hormonal contraception, both women using NuvaRing and the Pill reported a global improvement of sexual function.


[*quote slightly modified for clarity]

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Sunday, June 17, 2007

The Well-Timed Period In Top 100 Blogs on Health and Medicine

edrugsearch ranks TWTP #20 in its Top 100 Blogs on Health and Medicine. Cool! Note that TBTAM is right up there with TWTP, which can only mean one thing: Ob/Gyn blogs are poised to take over the world, mwuahahaha. [Women's Health News has more.]

Healthcare 100 - eDrugSearch.com

Friday, June 15, 2007

Implanon and Bleeding

Some facts about Implanon, the progestin-only [68 mg etonogestrel (3-keto-desogestrel)] single-rod implant device:

1. The contraceptive effect of Implanon is established within 24 hours after insertion; ovulation and fertility return within 1 month after the implant is removed.

2. The timing of insertion of Implanon is based on the patient’s menstrual cycle and current contraceptive method:

* For a woman who is not using a hormonal contraceptive, insertion should take place during the first 5 days of menses.

* For a woman who is actively using a cyclic hormonal contraceptive, the device should be inserted during the hormone-free interval.

* For a woman on a continuous hormonal contraceptive, Implanon can be inserted at any time.

* After pregnancy, the device can be inserted 3 or 4 weeks after delivery.

The Implanon rod can be removed at any time. It must be removed after 3 years of use.

The Implanon rod was originally studied in women who weighed no more than 130% of their ideal body weight. The effectiveness of Implanon in obese women has not been thoroughly assessed in a large population study.

3. Implanon is not associated with loss of bone mineral density (BMD).


What is the major side effect of Implanon?

Frequent or unpredictable bleeding (or both) is the major side effect of Implanon.

In one study of 324 women who used Implanon, continuation rates were 75%, 59%, and 47% at 1 year, 2 years, and 2 years-9 months, respectively. Of women who discontinued Implanon, 91% did so because of frequent or unpredictable bleeding or both. In another study, the continuation rate was 66% at 1 year.


Why the unpredictable bleeding?

Women using Implanon who have higher circulating estradiol levels and ovarian follicle activity may be at greater risk of abnormal patterns of bleeding.

Women using progestin contraceptives who have abnormal uterine bleeding have elevated levels of endometrial enzymes, such as matrix metalloproteinases and neutrophil elastase, that prevent epithelial tissue repair.


A possible solution

In a preliminary report, women with prolonged bleeding in association with Implanon were randomized to various treatment regimens, among which were doxycycline, 100 mg twice daily for 5 days, or placebo. Doxycycline treatment significantly reduced prolonged bleeding compared with placebo (4.8 days [95% confidence interval (CI), 3.9 to 5.8 days] versus 7.5 days [95% CI, 6.1 to 9.1 days], respectively).

Doxycycline may inhibit these [endometrial] enzyme systems and enhance repair of endometrial epithelial tissue. Whether doxycycline will become a widely used treatment for prolonged bleeding associated with Implanon remains to be determined in additional clinical trials.


Implanon

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Embrace the IUD

The findings of a study of knowledge of intrauterine devices among adolescent and young adult women suggest that young women may not be getting sufficient information on all of the contraceptive options available to them, particularly IUDs.

If I were in charge [of the world, mwahahaha], I'd make sure all people of reproductive age are thoroughly conversant with the IUD, one of the best methods of birth control available--safe, effective, and unobtrusive.

Back to the study:

In a cross-sectional survey of 144 young women between the ages of 14 and 24 recruited from an adolescent gynecology clinic, gynecology outpatient clinics, and the community, more than half of the participants had never heard of an intrauterine device (IUD) and 97% had never used one, said Dr. Lisa Johnson of the adolescent medicine division of the Nassau (Bahamas) Department of Public Health.

The 20-minute, 44-item, semistructured interview assessed demographics, sexual history, contraceptive use and attitudes, and IUD knowledge and attitudes, Dr. Johnson said. The mean age of the respondents was 18.8 years. Nearly all (97%) of them were single, 58% were African American, and 39% were white. Approximately 84% of the group had ever been sexually active, with a mean age of 15.8 years at first sexual intercourse and a median of three lifetime partners. Among those who had ever had sex, 76% had ever been pregnant and 67% had ever had a sexually transmitted disease.

According to the survey results, 60% of the young women surveyed had never heard of an IUD, yet a majority of them “agreed” or “strongly agreed” that they would consider a birth control method that resulted in less painful (93%) and lighter (91%) periods and gave them control over when to stop (85%) and start it (80%), Dr. Johnson said. In addition, 61% reported being “willing” or “very willing” to use a birth control method that causes irregular vaginal bleeding if it was 99% effective at preventing pregnancy, she said.

However, only 30% of the respondents said they would consider a birth control method that involved placing a small plastic object in the uterus and only 27% said they would be interested in a device that had to be placed and removed by a health care provider, she noted.

...

Among the young women who liked the idea of an IUD, the most appealing characteristics were that it did not require them to remember to use it every day, that it would not affect their ability to have children in the future, and that it did not need to be remembered with each sex act, Dr. Johnson said.

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Uterine Fibroid Myths

Five uterine fibroids myths, from a presentation at the meeting of the Obstetrical and Gynecological Assembly of Southern California. [For more on myomas, including some excellent (Warning: graphic!) intraop pics, go here and here.]



▸ Myth No. 1. A rapidly growing fibroid could be or become a leiomyosarcoma [cancerous].

▸ Myth No. 2. If you can't feel the ovaries because fibroids are in the way, you need to do a hysterectomy because if the patient develops ovarian cancer you would never pick it up.

▸ Myth No. 3. Intramural [inside the uterine wall] fibroids will impair fertility so we need to take them out.

▸ Myth No. 4. Fibroids will just grow back after myomectomy, so one might as well do a hysterectomy.

▸ Myth No. 5. Hysterectomy is safer than myomectomy.

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Thursday, June 14, 2007

Canadian Friends With Benefits

A man has an argument with a guy he knows; the man attacks this person. He punches and kicks the guy, and tries to prevent him from calling the police by cutting his phone cord. Finally, the man stabs himself with a butcher knife.

The judge in the case decides that (1) the 146 days the man has already served in pre-trail custody was enough jail time, and (2) the appropriate sentence is: Not allowed to have a guy friend for the next three years.

Because, you see, it's not about the man's lack of impulse control; his inability to control his actions vis-a-vis others and himself. It's not the assaulting, the cutting of the phone cord, and the stabbing of self.

No, no. The problem here is that the man cannot from a relationship of a civilized nature with a male person.

Wednesday, June 13, 2007

Cockroaches-1, Reuters-0

Scientists find that cockroaches have memory, and Reuters reminds us of Pavlov's 1990s classical conditioning research with dogs.

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Monday, June 11, 2007

Mozambique To End Abortion Ban

MAPUTO (AFP) - Mozambique is set to end its blanket ban on abortion after the government acknowledged that current legislation was endangering the lives of women in one of Africa's most impoverished nations.

The proposed shake-up follows the release of a report by the health ministry which said around 100 pregnant women were dying every year after seeing backstreet abortionists while many more suffered "serious after-effects."

Abortion was first outlawed in the former Portuguese colony in legislation dating back to 1886, a ban reaffirmed in a 1981 law six years after the southeastern African country gained independence.

...

According to the health ministry, 30 percent of women admitted to Maputo's main hospital following a backstreet abortion end up dead.

Figures compiled by the UN's World Health Organisation show that some 68,000 women die annually due to unsafe abortions, most in developing countries such as Mozambique -- which is still reeling from a devastating 1976-1992 civil war that claimed up to one million lives.

The influential Catholic Church is firmly against decriminalisation, with the Archbishop of Maputo, Francisco Chimoio, even declaring last month that women who terminate pregnancy can expect to "live their lives in fear of divine punishment."

The admonition has not daunted women's groups.

"We should follow the path that has been taken by Portugal in decriminalising abortion," after a February referendum there, said Graca Sand, who works for the Forum Mulher, a charity for impoverished women.

Abortion still remains taboo in much of Africa where many countries have a blanket ban. Although South Africa does allow termination of pregnancy on demand, it is illegal in Mozambique's other neighbours, Malawi, Zambia and Zimbabwe.

According to the Mozambican health ministry, 58 percent of women who have had an abortion did so at home, very often without the help of anyone with medical training.

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Saturday, June 09, 2007

Vaginal vs. Oral Misoprostol

Interesting report on misoprostol regimens. I don't have access to the study on the computer I'm on, but according to the article:

In this study, Dr. Helena von Hertzen, of the Department of Reproductive Health and Research at the World Health Organization, and her colleagues studied 2,046 women who were divided into four groups that received misoprostol either vaginally at three- and 12-hour intervals, or under the tongue at three or 12-hour intervals.

Among women who took misoprostol at 12-hour intervals, pregnancy continued in 9 percent of those who took the drug orally and in 4 percent of those who took it vaginally. Among those who took the drug at three-hour intervals, pregnancy continued in 6 percent of those who took it orally and in 4 percent of those who took it vaginally.

Side effects such as nausea and vomiting were more common among women who took misoprostol under the tongue and vaginally at three-hour intervals than among those who took the drug at 12-hour intervals. Side effects such as pain, diarrhea, chills and shivering were slightly higher among women who took the drug orally.

"Administration interval can be chosen between three hours and 12 hours when misoprostol is given vaginally. If administration is [oral], the intervals between misoprostol doses need to be short, but side effects are then increased. With 12-hour intervals, vaginal route should be used, whereas with three-hour intervals either route could be chosen," the study authors concluded.


A couple of points.

1. You could use misoprostol (Cytotec) alone, but you shouldn't (for now, anyway. Once abortion is outlawed, we'll revisit the recommendation.). Adding mifepristone (RU-486, Mifeprex) to the regimen improves efficacy and reduces side effects.

Note: I'll have more on the misoprostol/mifepristone (RU-486) drug regimen in Part II of my post exposing Senator Jim DeMint (R-SC) lies in support of his amendment to regulate mifepristone (RU-486). [Part I, here.]

In the interim, and without looking it up, try to answer this question: Why do the two drugs work better together? What's more likely: A) the drugs have different actions, or B) the drugs have similar actions, and one potentiates the other?

2. Vaginal misoprostol is not part of the FDA-approved regimen. FDA approved 600 mg mifepristone (RU-486) and 400 mcg misoprostol, both administered orally.

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Have A Miscarriage, Go To Jail

***UPDATED***

Allegheny County District Attorney Stephen A. Zappala Jr. has brought charges against Christine Hutchinson, a 22 yo Pittsburgh woman, for failure to report her spontaneous abortion to the State.

According to Mr. Zappala’s spokesman, Mike Manko, the local laws have been researched and there exists a law on the books in Allegheny County whereby a woman is to be charged with concealing the death of a child if she fails to promptly inform the State she miscarried.

I'd like to take a closer look at this law, and I encourage you to do the same. Here's the contact info for the Allegheny County District Attorney's Office:

Tel: 412-350-3123
e-mail: feedback@da.allegheny.pa.us

And here's the mailing address: Allegheny County District Attorney's Office, Room 303 Courthouse, 436 Grant Street, Pittsburgh, PA 15219. You know, just in case you have some clean pads/tampons and red ink lying around, and you want to get an early start on your miscarriage reporting.


(via Pandagon)

UPDATE: Thanks to reader Lisa, we have the law:

Pennsylvania Consolidated Statutes
CRIMES AND OFFENSES (TITLE 18)
CHAPTER 43 OFFENSES AGAINST THE FAMILY
SUBCHAPTER A - DEFINITION OF OFFENSES GENERALLY
§ 4303. Concealing death of child.

(a) Offense defined.--A person is guilty of a misdemeanor of the first degree if he or she endeavors privately, either alone or by the procurement of others, to conceal the death of his or her child, so that it may not come to light, whether it was born dead or alive or whether it was murdered or not.

(b) Procedure.--If the same indictment or information charges any person with the murder of his or her child, as well as with the offense of the concealment of the death, the jury may acquit or convict him or her of both offenses, or find him or her guilty of one and acquit him or her of the other.

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Sunday, June 03, 2007

Appeal For Donations

Give me more than $1 million, and I, too, will [tour] the state...with a slide show featuring...data and...images of sexually transmitted infections.... The twist? My information will be medically accurate and educational.

Just don't appoint me to any Presidential Advisory anything, or as an adviser to any health governmental agency as I'm afraid the proximity to politicians would cause the onset of a generalized flare-up of urticaria. And occasional bouts of slapping the twits silly.

Seriously now, read the linked article (via feministing) and marvel. And once you're done doing that, tell me something. How exactly are we supposed to combat this super well-funded, well-connected propaganda enterprise? Just countering the lies and misinformation with facts doesn't even begin to make a dent.

I'm open to suggestions...and multi-million dollar grants.

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Friday, June 01, 2007

Priapism Is A Bug, Not A Feature

I was all set to learn details about a newly discovered spermicide in the venom of Chile's black widow spider, and all I got was a marketing pitch, and confusion about what's desirable in a contraceptive. [For the record, priapism and involuntary ejaculation aren't selling features for a spermicide.]

SANTIAGO (Reuters) - Scientists have discovered a potentially marketable contraceptive in the venom of Chile's black widow spider, whose bite is fatal to many but can also cause prolonged, painful and involuntary erections in men.

The venom of the Latrodectus mactans, a variety of black widow found only in the south of Chile, has spermicidal properties not found in black widows in other regions of the world, Chilean Dr Fernando Romero said.

Romero heads a research team that has studied the spider's venom for seven years, prompted by tales of Chilean farmers who acquired superhuman virility after being bitten by the black widow.

Initial studies focused on taking extracts from the venom to treat erectile dysfunction, but they soon discovered it had a molecule that also made it an effective contraceptive.

...

He said he believes the molecule's natural properties are superior to those of synthetic spermicides currently on the market.

...

Romero, based at the Universidad de la Frontera in the southern city of Temuco, has already applied for a patent for his erectile dysfunction medicine.

His team discovered the property after looking into Chilean folklore that describes a virile man, one known to have spectacular sexual energy or many sexual partners, as being "spider-bitten."

...

Romero said he was confident his research would be complete in a couple of years and the spermicide would become available to world markets.

"We have to make sure there are no side effects ... so that it can be used as a gel in combination with condoms, or as suppositories for women."

Rural Residents And Cervical Cancer Rates

HOUSTON — Rates of cervical cancer are higher for women living in rural areas than for those living in cities, Vicki Benard, Ph.D., reported at the annual meeting of the American Society of Preventive Oncology.

...

Census county codes were used to categorize residents as rural, suburban, or metropolitan. A total of 39,946 cervical cancer cases were reported. Among metropolitan dwellers, the case rate was 11.8 per 100,000 residents; for those in the suburbs, the rate was 13.2 per 100,000; and for rural residents, the rate was 13.8 per 100,000, Dr. Benard reported.

When broken down demographically, black women had the highest rate of cervical cancer at 17.1 per 100,000 residents, followed by 11.4 per 100,000 for white women, 9.9 per 100,000 for Asian/Pacific Islanders, and 7.2 per 100,000 for American Indian/Alaska Natives. Age also factored into cervical cancer rates: Women aged 45 years or younger living in metro areas had a rate of 14.5 per 100,000, compared with 17.2 per 100,000 for rural women.

Dr. Benard and her colleagues speculated that the disparities are due to income, access to care, or quality of health care, but the study did not measure these factors. The study findings are especially timely, as screening and vaccinations against human papillomavirus become available. “Rural areas may need special education and outreach,” Dr. Benard said.


Having worked in both environments--metro and rural--I can tell you that the findings are in line with my clinical experience, as far as cervical dysplasia is concerned. I was quite surprised at the prevalence of high-grade lesions in my rural patient population (mostly white, young, lower middle class/poor). And, at least in that population, access to care and quality of care were not significant issues.

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Weight-Loss Motivator

This is what 53% total body fat looks like:



And, after an aggressive diet and exercise program, 18% total body fat:





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