Dog Zen

It's Monday morning, time for Rule of Dog.

The Proper Way to Steal Money From the Elderly

When you are a politically connected head of a city nonprofit and you decide to steal money from the nonprofit there's a right way to go about it and then there's a wrong way.

The wrong way is the Margarita Villegas way when you yourself just outright embezzle the money, steal only a measly $50,000, and admit what you did and express regret when found out.

The proper way is the Rev. Floyd H. Flake way. You use public money to build and run an apartment complex for the elderly. You then sell the complex to a for-profit partnership, a partnership you secretly have a 99.9% controlling interest in, and one you structured in a way that allows you to decide what fees to pay yourself, and to receive tax brakes from the city.

To insure your con is of the utmost professionalism, the lawyer you hire to get the mandatory approval from the attorney general's office also works as a consultant for the AG's campaign for governor, you request an emergency ruling for the final approval from the court in order to get a perfunctory review of the 600-page petition by the judge, and, cherry on top of the layered bamboozle, you insure that the clerk of the court who signs the approval is the mother of one of the for-profit partners who's buying the property.

Last, but not least, you then decide how many millions of dollars you should pay yourself for the service of fleecing the elderly and the taxpayers.

For the Man In Your Life Who Wants That Uterine Look

Dr. #1 Dinosaur made my day:

Photo by Demotivational Posters

Dog Zen

It's Monday morning and there's a special treat for you at Rule of Dog.

On a related note, I've just figured out you can incorporate dog toy adds from Amazon.com in blog posts (hey, better late than never!) so I promptly added them and then went to Amazon and bought everything in sight. Um, this is how blog advertisement is supposed to work, no? Anyway, I hope our dogs derive as much pleasure from playing with the toys we get for them as we do from buying the toys for them.

I dare you to resist the caterpillar!

Dr. Charles' Examining Room and Ob/Gyn Blogs

Dr. Charles' blog The Examining Room of Dr. Charles has a new address. Please update your bookmarks and make sure you visit him often. He is an outstanding medblogger well worth your reading time.

And speaking of blogs worthy of your reading time, I've finally grouped all the Ob/Gyn blogs in the sidebar under a separate heading to make it easier for you to spend countless hours reading blogs by The Best, The Beautifulest, The Brightest Ob/Gyns.

ellaOne, the New Emergency Contraceptive Pill That Confuses the AP to No End

What is so complicate about the emergency contraceptive pill (ECP) that any MSM article about emergency contraception will invariably contain mistakes?

Take this example from a few months ago from the AP, New morning-after pill works for up to 5 days.

The article reports on a study that compared one type of ECP, ellaOne (30 mg ulipristal acetate), with another, NotPlan B (1.5 mg levonorgestrel). [I'll explain the reason for the made-up brand name in a moment.]

Briefly, ellaOne is an ECP from HRA Pharma containing 30 mg of ulipristal acetate, a progesterone receptor modulator that works primarily by delaying inhibiting ovulation. [It also works by delaying ovulation, but it's less effective, depending on the timing of administration.]

Here's what the AP article manages to get wrong (and why it matters):

ellaOne and NotPlan B

International researchers compared Plan B to the new drug ulipristal acetate, sold as ellaOne in Europe only with a doctor's prescription. The drug is not legally on the market elsewhere.


Experts tracked nearly 1,700 women aged 16 to 36 who received emergency contraception within three to five days of having unprotected sex. About half got Plan B while the rest got ellaOne.

So researchers compared Plan B with ellaOne, right? Wrong.

The researchers compared a single dose of 1.5 mg levonorgestrel with one of 30 mg ulipristal acetate. That is, they compared NotPlan B with ellaOne .

Plan B is a two-pill (two 0.75 mg levonorgestrel doses) regimen brand. [The other two-pill brand is Next Choice, the generic for Plan B.]

The one-pill (one 1.5 mg levonorgestrel dose) regimen brands are Plan B One-Step, the i-Pill / Nextime, and Levonelle One Step.

So why does it matter that the article confuses Plan B with Plan B One-Step? After all you can take both Plan B pills at the same time and, voila, one 1.5 mg dose. Two reasons.

First, medicine is not politics or religion. Facts and accuracy count especially when it comes to drug names, dosages, and regimens. A drug's efficacy and safety profile depend on the dosage and regimen. Just because you can use a drug on a modified regimen does not mean that Plan B magically transforms into Plan B One-Step.

Second, Plan B is no more. It has ceased to be. It's expired and gone to meet its maker. The manufacturer has discontinued Plan B and it's replacing it with Plan B One-Step.

On top of an incorrect report on what the researchers studied, the AP misses an opportunity to inform you of the rather important development that Plan B is no longer available. It also misses the opportunity to introduce Plan B One-Step, the replacement, and discuss how it differs from Plan B and what you need to know to use Plan B One-Step properly.

New morning-after [EC] pill works for up to 5 days...just like the old one

From the headline, New morning-after pill works for up to 5 days, to the key paragraph:

LONDON – A new type of morning-after pill is more effective than the most widely used drug at preventing pregnancies in women who had unprotected sex and also works longer, for up to five days, a new study says.

The report was published Friday in the British medical journal, Lancet.

Levonorgestrel, the most widely used emergency contraceptive pill, is only effective if women take it within three days of having sex.

So, the new ECP ellaOne works longer, for up to five days, than the older levonorgestrel brand which is only effective if women take it within three days of having sex, right? Once again, wrong!

First, the statement that levonorgestrel ECP brands are only effective if taken within three days of having unprotected intercourse is flat out wrong.

Both the two-pill regimen [1st pill taken as soon as possible after sex; 2nd dose 12 hrs later] and the one pill regimen [pill taken as soon as possible after sex] are effective if taken within 5 days of having unprotected intercourse.

It goes without saying that you shouldn't wait for 5 days to use ECPs. If you are sexually active and are not planning a pregnancy you should keep the i-Pill / Nextime handy because the sooner you use the ECP, the more effective it is. But since none of us live in Perfect, there will be instances when, for whatever reason, you're not able to take the ECP right after having unprotected intercourse.

It is important for you to know that you have up to 5 days to use ECPs to protect yourself, and it is irresponsible for the AP to give you the wrong information.

Second, the Lancet study did not show that the new ECP ellaOne is better than the levonorgestrel brands. Rather, what it did show was what the study was designed to show, namely that ellaOne was no worse than Plan B One-Step. This may seem like a distinction without a difference, but it's not.

It's quite likely that ellaOne is more effective than the levonorgestrel brands when taken 3 to 5 days after unprotected intercourse but that hasn't been established yet and you should know that when deciding if ellaOne is the best emergency contraceptive option for you.

And since I mentioned that ellaOne (ulipristal acetate, or UPA) might be more effective, here's a bit more detail on that:

The reason [30 mg UPA prevented significantly more pregnancies than did levonorgestrel in the 72-120 hour subgroup] seems to be that UPA can delay ovulation when taken closer to ovulation than can levonorgestrel. By the time the leading follicle reaches 15-17 mm, follicular rupture is prevented within 5 days no more often after levonorgestrel administration than after placebo administration. In contrast, when taken when the leading follicle reaches 18-20 mm (and ovulation should occur within 48 hours) and the probability of conception exceeds 30%, UPA prevents follicular rupture within 5 days of administration in 59% of cycles, compared with 0% in placebo cycles. Follicular rupture failed to occur within 5 days after treatment with UPA in all women treated before onset of the LH surge, in 79% of women treated after the onset of the LH surge but before the LH peak, and in 8% of women treated after the LH peak. Another study found that ulipristal acetate altered the endometrium, but whether this change would inhibit implantation is unknown.

Bottom line: The sooner you take ECP after unprotected intercourse the better. All dedicated ECP brands--Next Choice, Plan B One-Step, i-Pill/Nextime, Levonelle One Step, and ellaOne--work for up to 5 days after unprotected sex. It remains to be seen if ellaOne is more effective in the 3-5 days period. Last, but not least, when you read a MSM article on ECP just assume it's wrong and go form there.

What Is Happening to My Beloved State?

I guess if you live in a place where the mere mention of the word "genitals" prompts the TV news person to issue a warning about offensive statements, it's not all that surprising that the State has the power to charge you with cheating on your husband:

A woman arrested for public lewdness for allegedly having sex in a park is facing a surprising additional charge: cheating on her husband.

No, this wasn't in a Muslim country far away, it is happening in New York.

Suzanne Corona, a 41-year-old woman from Batavia, N.Y., just east of Buffalo, was busted along with 29-year-old Justin Amend last week, police said.

The pair allegedly were having sex on a picnic table near a playground in Farrall Park just after 5 p.m. on Friday, according to WHAM 13.

And speaking of my beloved state, how about my beloved city?

Totalitarian piece of garbage Council Speaker Christine Quinn is supporting that other piece of dreck the Catholic League's Bill Donohue in his bullying of the owners of the Empire State Building.

But wait, there's more! Not to be outdone, an outraged City Council will demand Wednesday that the Empire State Building drop its opposition to honoring Mother Teresa with blue-and-white lights on her 100th birthday.

Because what better use of government power and resources than hassling a private enterprise to honor a poisonous little promoter of pain and pauperdom?

The 7-Inch Cure to Your Sexual Slump

Photo by Northampton Museum

Ladies, is your confidence low? Do you feel powerless? Are you forced to ponder the meaning of life as you go through a dry spell, unable to get laid? Not to worry, Amanda Sidman of the NY Daily News is here to fix what ails you.

Just strap on a pair of 7-inch heels and feel the empowerment surge through your bunions. Because, clearly, what man in his right mind can resist a woman who

• has trouble walking

• needs a wall to steady herself as she descends a flight of stairs

• struggles to stay upright

• is forced to needlessly spend money on overpriced taxis

• purposefully incapacitates herself so that she can depend on the kindness of strangers to carry her across the street

If you ask me, Ms. Sidman overlooks the obvious. Forget spike heels. Just cut off your toes altogether, sit yourself on the curb with your pretty little stumps and you are guaranteed to have men swarming around you. Granted, they'd most likely be drawn to you out of concern for your health (mental and otherwise) and they'll be speed dialing 911 but, hey, just think how empowering all that male attention will be.

Outsourcing Pregnancy

Photo by Henna by Heather - Mehndi in Boston/Providence M

Is there any outsourcing need India is unable to meet? Apparently, not, at least when it comes to surrogate pregnancies, according to this very informative Time article:

India has become the world capital of outsourced pregnancies, whereby surrogates are implanted with foreign embryos and paid to carry the resultant babies to term. In 2002 the country legalized commercial surrogacy in an effort to promote medical tourism, a sector the Confederation of Indian Industry predicts will generate $2.3 billion annually by 2012. Indian surrogate mothers are readily available and cheap. Unlike most countries in which surrogacy is lawful — and bucking the norm in heavily bureaucratic India — the procedure can take place without reams of government red tape.