Knowledge of Birth Control in Hong Kong

Adequate reproductive health information seems to be in short supply all over the world. From a survey of 502 single Hong Kong women ages 18 to 40:

• unaware condoms could prevent both pregnancy and STIs - 30%

• thought condoms could only be used to prevent pregnancy - 17%

• said condoms are more reliable at preventing pregnancy than the Pill - 46%

• not aware of the benefits of oral contraceptives - 58%

According to a local Ob/Gyn, many women are reluctant to use some methods of contraception because of pressure from their partners or beliefs, such as oral contraceptives leading to weight gain.

Painful Nipples and Raynaud's

You're breast-feeding, your nipples are very painful, but without any signs of infection and no cracks or fissures. Is it a yeast problem or a far less common condition (one you should be aware of, nonetheless) called Raynaud's phenomenon of the nipples?

Here are a few facts about Raynaud's phenomenon of the nipples.

Raynaud's of the nipples is a rare cause of nipple pain characterized by vasospasm of the nipples while breast-feeding. The spasm-like throb is usually bilateral and severe. The nipple usually turns very white but may be blue, purple, or red.

Women with a history of Raynaud's syndrome are more likely to experience this problem. As are women with conditions associated with factors that restrict the blood vessels, like rheumatologic diseases, endocrine diseases, autoimmune diseases, cigarettes, and caffeine.

Last, but not least, if Raynaud's phenomenon is the cause of your nipple pain, the following should help:

• Avoid exposure to cold, vasoconstricting medications, nicotine, and caffeine.

• Warm compresses or warm showers (may suffice as treatment for mild cases).

• Topical nitroglycerine.

The drug treatment of choice is the calcium channel blocker nifedipine, a vasodilator, (5 mg b.i.d. for 2 weeks).

"The Crackpot Who Sued PZ Myers"

That would be one Stuart Pivar. (Make sure not to miss Blake Stacey's excellent roundup of links on l'affaire Crackpot, in particular the one from an attorney who spoke with crackpot's Pivar’s lawyer, Michael J. Little.)

As vaguely amusing and abstract as all this might seem, let's not forget that frivolous lawsuits are nothing to sneeze at, ever. The stress on Professor Myers and his family is all too real. We (and by that I mean me) stand at the ready to support our leader, but for now we sit and wait.


(post title swiped from Making Light)

Public Nudity, Putin Style

President Putin poses semi-nude in public (granted, while on vacation):

(via)

And still I maintain that public nudity only serves to expose one as vulnerable, the antithesis of powerful. My first thought on seeing the picture was "Wow, that's reckless; a sniper would have such an easy shot!" My second thought: "Leaving something to the imagination...always the way to go."

(via)

"Condom Bindaas Bol" And Bill Donohue

"Say Condoms Freely", the slogan for an Indian public awareness campaign designed to encourage the use of condoms has won this year's UN Grand Award, a UN public relations award.

You have to admit "Condom Bindaas Bol" is beyond catchy, it's cool. [No, I don't speak the language, so my pronunciation is probably off but I still love it.] As is the message behind the slogan that 'condom' is not a delicate word and it should be discussed freely.

Which brings us to Bill Donohue and his reaction to Manhattan Mini Storage's temerity to run a billboard with a a factual reproductive health message:

There is a billboard on Manhattan’s West Side Highway, at 44th Street and 12th Avenue, that shows a large wire hanger with the inscription, “Your closet space is shrinking as fast as her right to choose.” The ad was placed by Manhattan Mini Storage, owned by Edison Properties.

Catholic League president Bill Donohue spoke to this issue today:

“New Yorkers are accustomed to Manhattan Mini Storage posting billboards that bash the Bush Administration, but when it makes the leap from partisan politics to crude cultural commentary, it is stepping on dangerous turf. Why a storage company finds the need to advertise its support for abortion is a story all of its own, but when it seeks to depict the pro-life community—which is primarily Catholic and Protestant—as oppressive, then a line has been crossed.

“Those who like this billboard would no doubt be aghast at the sight of a billboard that featured a bloody baby who survived a botched abortion. They would be even more incensed if the picture were accompanied by the remark, ‘This is what happens when abortion fails.’

“Manhattan Mini Storage is not only guilty of crudeness, but of cowardice. To wit: Why didn’t it have the guts to identify the object of her ‘shrinking’ choice?”

This is a good piece of propaganda and your mission, should you choose to accept it, is to go through the statement, examine Mr. Donohue's propaganda technique, and, most importantly, learn from it. Why? Because when combating malignant ideologues [are there any other kind?] like Mr. Donohue reality, facts and righteous indignation are not sufficient. To be effective you have to become thoroughly conversant with the tricks of the trade employed by people like Mr. Donohue.

Women Receive Insufficient Reproductive Health Information

When it comes to knowledge and understanding of using a continuous Pill regimen to skip or eliminate the menstrual period it looks like women and their doctors are talking past each other.

From a survey of 500 women and 300 physicians:

• 63% of women reported being “somewhat” or “extremely” interested in not having a period, but only 17% of MDs reported that their patients indicated they did not want a period.

• Only 20% of women reported they “strongly agree” or “somewhat agree” that having their period is not medically necessary, while 97% of MDs reported that continuous OC use is medically acceptable.

• Few women (12%) reported talking to their MD about eliminating or reducing their periods; of these, 71% reported that they raised the topic. However, 80% of MDs reported mentioning continuous OC use when discussing contraceptive options; when continuous OC use was discussed, 77% of MDs reported that they raised the topic.

The study concludes that women and their MDs have different understandings of the medical implications of menses inhibition, and women may be receiving insufficient information. Gee, you think?

I'm not exactly sure why we're having this problem. I do think it has a lot to do with 1) the short duration of a well care visit and the inability to spend enough time on patient education, and 2) the assumption that this information is so basic that patients already know about it. [I must admit this is an easy trap to fall into occasionally. Just the other day I assumed a woman knew what lochia was just because she was a multip. Very bad form on my part.]

Spending more time with the patient would be ideal, but, unless we figure out how to be in two places at the same time, I don't think that's a feasible solution. So the best way to go about it is to insure that women receive, and are familiar with, most of the background information before they come in.

If you already know the basics about the menstrual cycle, the Pill's mechanism of action, and the Pill brands and regimens used to skip the period, you can use the office visit to fine tune, to tailor your options to best suit your particular needs.

Now all that remains to be done is to find a way to insure all women are up-to-date on the basics of reproductive health.

The Government Can Do No Wrong

Boxes of files from the Walter Reed Army Institute of Research, containing personal medical information, are found dumped in a random trash bin, on a random street. No charges are filed because the police do not believe anyone had access to the information other than the person who found the records and called authorities.

Good to know that if I decide to follow the government's lead and discard some patient records in a trash bin on the street I, too, will be given the benefit of the doubt and be absolved of any responsibility.

So I'm off to breach patient confidentiality and suffer no consequences for it.

Over-the-Counter Birth Control Pills

If birth control pills were available over-the-counter (OTC) would you buy them? And, more importantly, should you?

Judging from the results of a study of over 1,000 women, buying the Pill OTC would likely be safe, especially for younger women....

Women in many countries can buy birth control pills over-the-counter(OTC). Not so in the US. Here a prescription (meaning a doctor's visit to screen for contraindications to Pill use) is required.

Even with the screening requirement, approximately 6% of COC [combination oral contraceptive] users in the US are contraindicated for use.

So researchers wanted to see how well women could self-screen for contraindications to Pill use. The women were given a checklist and asked to determine if they had any of the Level 3 or 4 contraindications to Pill according to the WHO Medical Eligibility Criteria. The results:

The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5–86.3%) and specificity 88.9% (86.4–91.0%). 6.7% (5.3–8.0%) of women incorrectly thought they were not contraindicated when they truly were, largely due to unrecognized hypertension of >140/90 mm Hg. Using a cut-off of 160/100 mm Hg (WHO Category 4 contraindication), 2.6% (1.7–3.5%) incorrectly thought they were not contraindicated. In regression analysis, younger women, more educated women and Spanish-speakers were significantly more likely to correctly self-screen (p<.05).

The study concludes:

The percentage of women who incorrectly self-identified as not contraindicated (6.7%) is similar to the proportion of actual pill users in the US who are contraindicated for use (6%). Over-the-counter provision of COCs would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

So, what do you think; if you could purchase the Pill OTC, would you?

Do You Want To Marry An Infant?

Well, come on down to Arkansas where [a] law passed this year allows Arkansans of any age — even infants — to marry if their parents agree....

According to this new law:

In order for a person who is younger than eighteen (18) years of age and who is not pregnant to obtain a marriage license, the person must provide the county clerk with evidence of parental consent to the marriage.

Here's the background story. Before the new law took effect July 31, girls could get married with parental consent at 16 and boys at 17. Realizing that that's probably a tad too young, the Arkansas legislators wanted to pass a new law to establish 18 as the minimum age to marry.

But, unable to resist the urge to "other" females of reproductive age, no matter how young, the politicians decided to make an exception for pregnant teenagers and allow pregnant teenagers to marry with parental consent. [The logic, if any, for this exception eludes me.]

Anyhow, since legislators are not actually expected to be familiar with, or responsible for, the laws they pass, the politicians missed an extraneous "not" in the bill which allows anyone who is not pregnant to marry at any age if the parents allow it.

Commenting on the new law Sen. Sue Madison had this to say:

I am concerned about pedophiles coming to Arkansas to find parents who are willing to sign a very young child's consent.

Maybe the people of Arkansas would be better served if only there were some concern about the incompetence and poor job performance of those responsible for enacting such a law in the first place.

Central Park Pics

Central Park @ 58th Street

Central Park @ 58th Street, II

Central Park/Madison Ave.

Reducing The Deficit, One Birth Control Pill At A Time

President Bush signed The Deficit Reduction Act Of 2005 because, according to the White House, [t]his legislation restrains Federal spending and leaves more money in the hands of the American people.

Judging by the effects of this federal law, which went into effect in January, it appears female collage students of reproductive age are neither American, nor people.

Not only doesn't the Deficit Reduction Act of 2005 leave more money in their hands, it actually manages to significantly increase their health expenses:

For decades college campus health centers have been a resource for budget-conscious female students seeking birth control. Because of agreements with pharmaceutical companies, most campus clinics were able to distribute brand name prescription contraceptives, from pills to the patch to a monthly vaginal device like NuvaRing, for no more than a couple of bucks.

That all ended earlier this year. Health experts say the price bump for college students was inadvertent — a byproduct of the Deficit Reduction Act of 2005, a federal law that went into effect in January. The law alters how drug makers calculate Medicaid-related rebates paid to states, but it ultimately made it expensive for companies to offer schools such deep discounts on birth control. As a result, brand name prescription prices for campus clinics rose from about the $3 to $10 range per month to the $30 to $50 range.

Ah, the joys of being a member of Congress! You get to enact legislation affecting people's lives and health but you're not expected to actually, you know, understand the law or its effects or, dare I even mention it, be responsible for the consequences.

The good news is that now we all, patients and politicians, together in perfect harmony, have something to look forward to like, for example, increase use of less effective birth control methods and more unintended pregnancies:

A 2006 survey conducted by the American College Health Association (ACHA) found that 39% of undergraduate women use oral contraceptives. Many providers are afraid that if the convenience of free or cheap birth control on campus is taken away, female students might just get turned off by prescription birth control methods altogether and use other less effective ones like condoms or Plan B, known as the morning after pill. Even switching to generic medications, most say, while better than nothing, isn't ideal because of the side effects that sometimes come along with them. "We do know that high fees act as a barrier to obtaining care. That is classically understood in campus health services," says Claudia Covello, director at the University of California-Berkeley's health center.

Prescription birth control — which includes the pill, the patch and NuvaRing — is 99.7% effective, according to Planned Parenthood, and many worry if students skip out on it or move to a method they're not as comfortable with, it can lead to more unwanted student pregnancies. "I think there are some who will just try to wing it and see how it goes. They'll say 'Well I go to school here, my boyfriend is in another city and I only see him once or twice a month and I won't use anything' rather than pay for something they can't afford. That's absolutely dangerous," says Dr. Nancy Jasper, an assistant clinical professor at Columbia University's medical school.

And speaking of less effective methods, note the following inaccuracy in the article:

Health officials say they discourage using Plan B as a regular form of contraception because, although there's no physical risk to doing so, students will be missing out on the menstrual cycle regulation and the required annual exams that come along with a regular oral contraceptive prescription.

The main reason you shouldn't use Plan B as your regular method of birth control is because Plan B is far less effective. Bleeding irregularities and missing annual exams are secondary considerations.

Last, but not least, I think asking the very people who were incompetent enough to enact this detrimental law in the first place for help is misguided and counterproductive:

AHCA, a college health advocacy organization, says that since it became aware of the Deficit Reduction Act they have been doing everything they can to fight for an exemption in the law for college health centers. The group's advocacy chair Mary Hoban says that while she's pretty sure the impact on college students was unintentional, their only recourse for the time being is a legislative fix from Congress. "We are contacting members in Congress to make sure they understand what the impact of the Deficit Reduction Act has on their campuses and asking for their help when they see an opportunity to legislate a solution to this," she says. But so far she says she hasn't had much luck.

Bottom line: If you're a college student on a budget, know this: Every time you ingest a Pill the Federal deficit shrinks.

Dominican Day Parade

The Dominican Day Parade is going strong on 6th Ave. I didn't have my camera, but I must tell you, the costumes were great and the dancing, terrific (made even more remarkable by the horribly hot weather outside). There was even an intruder--an older man in drag with a parrot on his head. Normally I don't like interlopers because I think it's rude to disrupt parades, but the man did make an effort to blend in with the marchers, and the crowd seemed to like his antics.

Some pics from last year's parade here, and here.

7 Birth Control Pill Brands You Need To Know

Seasonale and Seasonique, Jolessa and Quasense, Lybrel, Yaz and Loestrin. Between the squirrely brand names, the different types of regimens and the presence or absence of a placebo (hormone-free) interval, knowing which of these newer birth control pill brands is which can get a bit confusing.

To help you figure out which Pill brand might be the one best suited for your needs here's a brief comparison guide of 7 Pill brands you need to be familiar with.

First, an overview.

Type of pills: All these brands are combination pill brands because they have active pills (the pills containing hormones) in the pack with a combination of two hormones--an estrogen [ethinyl estradiol (EE)] and a progestin [either levonorgestrel (LNG), drospirenone (DRSP), norethindrone acetate (NEA) or desogestrel (D)].

Most of the brands are monophasic--each active pill in the pack has the same amount of hormones. Some brands are biphasic--most active pills contain the same hormone amounts, but a few pills have a different amount of only one hormone, EE.

Regimens: With some brands you take the active pills on a regular monthly regimen, other brands have an extended regimen (84 days), and two brands are continuous-use, meaning you take an active pill every day throughout the year.

Placebo interval: The hormone-free interval ranges from the regular one (7 days), to a shortened one (4 or 2 days), to none.

Second, the brands.

Seasonale, Jolessa, and Quasense
(Extended regimen, regular placebo interval.)

These brands have an 84-day active pill cycle, followed by a regular 7-day placebo interval.

Seasonale (Barr Labs)

One active pill [0.03 mg EE/0.15 mg LNG] for 84 days, followed by 7 days of placebo pills.

Seasonale

Jolessa (Barr Labs)

Same as Seasonale, 84 days of active pills [0.03 mg EE/0.15 mg LNG] followed by 7 days of placebo pills.

Jolessa (via)

Quasense (Watson)

Same as Seasonale, 84 days of active pills [0.03 mg EE/0.15 mg LNG] followed by 7 days of placebo pills.

Quasense (via)

TIP #1
Both Jolessa and Quasense are the generics for Seasonale.

Seasonique and Lybrel
(Continuous regimen, no placebo interval.)

These brands have a continuous active pill cycle; one active pill each day of the year. There's no placebo interval.

Seasonique (Barr Labs)

One active pill [0.03 mg EE/0.15 mg LNG] for 84 days, followed by another active pill [0.01 mg EE] for 7 days.

TIP #2
Addition of low-dose EE during the placebo interval provides greater egg development suppression in the ovary.

Seasonique

Lybrel (Wyeth)

One active pill [0.02 mg EE/0.09 mg LNG] taken daily with no placebo interval.

Lybrel (via)

TIP #3

Seasonique and Seasonale may sound alike, but they're not. Note that only Seasonique and Lybrel do away with the placebo pills. And just so we're clear, despite the media hysteria surrounding Lybrel's recent FDA approval, Seasonique was the first approved Pill brand to completely eliminate the placebo interval, not Lybrel.

Yaz and Loestrin 24 Fe
(Monthly regimen, shortened placebo interval.)

These brands have a 24-day active pill cycle, followed by a shortened 4-day placebo interval.

Yaz (Bayer)

One active pill [0.02 mg EE/3 mg DRSP] for 24 days, followed by 4 days of placebo pills.

Yaz

Loestrin 24 Fe (Warner Chilcott)

One active pill [0.02 mg EE/1 mg NEA] for 24 days, followed by 4 days of iron-containing placebo pills.

Loestrin 24 Fe

And as a bonus, two more shortened placebo interval brands you should be familiar with:

Kariva (Barr Labs)

One active pill [0.02 mg EE/0.15 mg D] for 21 days, a placebo pill for 2 days, followed by another active pill [0.01 mg EE] for 5 days.

Kariva

Mircette (Organon/Barr Labs)

Same as Kariva (and Azurette), one active pill [0.02 mg EE/0.15 mg D] for 21 days, then 2 days of placebo, followed by another active pill [0.01 mg EE] for 5 days.

Mircette

TIP #4

Kariva is the generic for Mircette.

Bottom line: If you're familiar with the characteristic features of these newer brands you can better judge which type of Pill will suit you. Use this guide as a starting point when you discuss Pill option with your Ob/Gyn.

Unverified Radiological Threat Made Against NYC

Channel 4 is reporting that an unverified radiological threat was made against New York City Friday:

The New York Police Department released the following statement:

"While the threat remains unverified, our counterterrorism posture, which is reconfigured daily based on intelligence from around the world, has been modified to include increased deployment of radiological sensors, including vehicle, marine and helicopter-mounted, as well as those carried by NYPD personnel."

Additionally, vehicle checkpoints were established in the city, including lower Manhattan, and at certain approaches to the city from neighboring jurisdictions.

Hmm, not sure what to make of this. The vehicle checkpoints with the specialized equipment are a new development, but on the other hand the only source cited by Channel 4 was a Debkafile report. In any case, if there really is a truck with a radioactive bomb cruising the city streets it's too late for reconfiguring deployments (ah, the bureaucratspeak, don't you just love it).

Bottom line: If my blog goes glowy all of a sudden, you'll know why.

The Marketing of Forced Pregnancies

Looking to China for guidance, American proponents of government controlled reproduction are hard at work on making forced pregnancies more palatable to the masses:

WASHINGTON, D.C. - America's top family planning agency has cracked down on crude and insensitive slogans used by rural authorities to enforce the country's strict forced pregnancy policy, state media said Sunday.

Slogans such as 'Raise more babies but fewer piggies,' and 'One less baby means one more unused womb,' have been forbidden and a list of 190 acceptable slogans issued by the National Population and Family Planning Commission, the official AMERIUSA News Agency reported.

Such slogans are often found painted on roadside buildings in rural areas.

America's 28-year-old family planning policy mandates most urban couples to have six children and allows some families in the countryside to stop breeding if they already have 12 children. Critics say it has led to forced deliveries, fertility treatments and a dangerously imbalanced sex ratio in the adult population due to the dropping off like flies of grand multips .

The American government contends that the forced pregnancy policy has helped bring about at least hundreds of millions of births and aided America's recent, rapid economic development, not to mention the country's overall awesomeness.

AMERIUSA said slogans such as "Houses toppled, cows confiscated, if forced pregnancy demand rejected," threatened to undermine America's efforts to keep the population under control.

Examples of authorized slogans include "Mother earth is not too tired to sustain more children" and "A bunch of unwanted boys and girls are parents' hearts," it said.

The commission said some slogans left the impression that the government was "simply forcing people to have babies against their will, causing misunderstanding (of) the policy and even tarnishing the image of the government," AMERIUSA reported.

Lybrel Available In Pharmacies

Lybrel (20 mcg ethinyl estradiol/90 mcg levonorgestrel), the new continuous use birth control pill brand, is now available in pharmacies, according to Wyeth.

I haven't noticed any TV ads yet, but I imagine they're forthcoming. I'll be curious to see how Wyeth handles conveying the no withdrawal bleeding message.

No HIV Risk Reduction For Abstinence-Only Programs

In an effort to examine the effectiveness of abstinence-only programs as a means of preventing HIV infection researchers analyzed 13 trials.

The findings:

Compared with no program, safer sex programs, and various other control programs, the abstinence-only programs did not seem to reduce HIV risk. Specifically, abstinence-only programs did not influence the rate of unprotected vaginal sex, the number of sexual partners, condom use, or initiation of sexual activity.

In one trial, there was evidence that abstinence-only programs may have had an adverse effect. Compared with a comparison group of young people who did not participate in an HIV prevention program, abstinence-only programs were associated with a rise in sexually transmitted infections and pregnancy. Still, the authors note that other trials did not show a significant link between abstinence-only programs and these outcomes.

In another trial, there was a suggestion that abstinence-only programs may reduce levels of vaginal sex, but the follow-up period was relatively short.

"In contrast to abstinence only programs, programs that promote the use of condoms greatly reduce the risk of acquiring HIV, especially when such programs are culturally tailored behavioral interventions targeting people at highest risk of HIV infection," Dr. Stephen E. Hawes, from the University of Washington in Seattle, and colleagues note in a relate editorial.

In related news, if you google "texas board of education" my post on the pronouncements of Don McLeroy, the president of the Texas State Board of Education, is right under the links to the official sites. Good! Maybe Mr. McLeroy manages to read it by mistake and takes a moment to reflect on his position that access to information doesn't help solve problems.

Evaluating The Program Designed To Prevent Pregnancies Among Accutane Users

Last year the FDA decreed that reproductive age women, in consultation with their physicians, are incapable of using Accutane, an acne drug, properly.

In order to protect women from themselves the FDA decided to only allow these women to receive proper care if they sign their life away 1) register their personal medical information with the government, and 2) submit to pregnancy tests. [Accutane is contraindicated in pregnancy.]

So the FDA paid a lot of money to a private company to enroll patients in a program (iPledge) designed to prevent pregnancies from happening in those patients.

It's now over a year later, and the results are in. Let's see how well 100 million dollars of your tax money protect women from themselves:

• 122 pregnancies reported in the program's first year.

[That's about the same as the number reported annually before the FDA tightened restrictions on the drug.]

• Another 37 pregnancies in the four months since.

• An additional 19 pregnancies in women who took the drug despite never enrolling in iPledge.

• Just 10% of the 122 women who conceived while taking the drug provided the detailed, follow-up information needed by the FDA to improve the program.

Faced with these stellar results of the iPledge program, the sage advisers to the FDA learn a lesson and decide that minor changes would ease access to Accutane and its generic competitors without further increasing those troubling pregnancies.

Not to be outdone, I also learn a lesson: I must get into this protecting-women-from-themselves racket. Not only is it lavishly funded--$100 million in Accutane protection here, half a billion or so in abstinence-only "education" there--but there is no expectation of, you know, actual results. If that's not the absolute cherry on top of the yummy cake of treating women like utter morons and getting paid for it I don't know what is.

Seriously, I can be as incompetent and patronizing as the next government subsidized person out there. So, if you have any ideas on ways to protect women from their very own selves feel free to send them my way.