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May 09, 2008Simple Innovation Saves Women's Lives
Around the globe, 500,000 women die every year from complications related to giving birth. The most common cause is obstetrical hemorrhage, or heavy bleeding, which can cause death in two hours or less. Consider that in many rural areas a hospital can be hours or even days away, and the urgency of medical attention becomes clear. Given this dire situation, some health researchers are working on promoting the adoption of less-invasive, evidenced-based medical practices to prevent excess bleeding from occurring during childbirth and simple innovations that can help stem the blood flow when there is a problem. One low-tech device that can be used to help women who are hemorrhaging and who don't have immediate access to maternity care interventions is the LifeWrap. Also known as a non-pneumatic anti shock garment (NASG), the LifeWrap -- which resembles a partial wet suit -- is made of neoprene and Velcro, and it literally wraps around the lower body, using pressure to treat shock, resuscitate, stabilize and prevent further bleeding in women with obstetric hemorrhage. Check out a video here to see how it works. Dr. Suellen Miller, director of Safe Motherhood Programs at the UCSF BIxby Programs for Global Reproductive Health, is currently conducting foundation-funded studies of the LifeWrap to treat maternal hemorrhage in Nigeria, Mexico, Egypt, Zambia and Zimbabwe. She is also working with Pathfinder International on a postpartum hemorrhage project in India.
What has the research shown so far?
In 2004, Suellen Miller, Dr. Paul Hensleigh, and their Egyptian colleagues, conducted a pilot study at four large hospitals in Egypt. Study participants who suffered severe obstetrical hemorrhage and shock were treated according to standard management or standard management AND the LifeWrap.
That's super impressive, but as the LifeWrap website points out, larger studies are needed, especially for funding.
These studies would provide the scientific, clinical and statistical evidence required by donor and advisory agencies (World Health Organization, UNICEF, UNFPA, USAID) before they will contribute the funds necessary to distribute the LifeWrap globally.
With Mother's Day around the corner, now's a great time to make a donation to LifeWrap to help speed up distribution -- $160 buys one LifeWrap, which can be used up to 50 times.
In other news this week, a University of North Carolina at Chapel Hill School of Public Health study that was published in the New England Journal of Medicine found that relatively inexpensive interventions helped health care providers in Latin America improve the way they treat mothers during labor and delivery, especially when it came to reducing blood loss.
The teaching techniques focused on behavioral change strategies aimed at modifying practices. According to the study, researchers were able to reduce the number and severity of episiotomies at public hospitals in Argentina and Uruguay and increase the use of the hormone oxytocin – which is given to mothers to make their uterus shrink and bleed less during the third stage of labor.
"Both of these changes greatly reduced the amount of blood mothers lost during childbirth, with mothers in the intervention hospitals losing 44 percent less blood," said Marci Campbell, a professor in the UNC School of Public Health whose research focuses on health interventions.
"This randomized trial showed that knowledge alone does not change behavior," Campbell said. "It takes the combination of opinion leaders, personal visits, reminders, and support to change behavior. This change is especially important for developing countries where maternal hemorrhage is a major health threat. However, the intervention also could be beneficial in developed countries, including many parts of the United States, where rates of routine episiotomy are still above optimal." May 08, 2008Daily Aspirin May Reduce Breast Cancer Risk
An aspirin a day may reduce the risk of developing the most common type of breast cancer by 16 percent, according to the results of a large study reported on by HealthDay News. The study by the U.S. National Cancer Institute appears in the April 30 online edition of the journal Breast Cancer Research. Researchers found that aspirin (but not other painkillers) reduced the risk of estrogen receptor-positive breast cancer, which accounts for some 75 percent of all breast cancers. Barbara Brenner, executive director of Breast Cancer Action, noted that the theory behind aspirin use has been around for many years (see, for instance, this BCA 2004 newsletter article). "If this works, it is a very exciting development for a lot of people who are thinking about how we can control not only cancer, but the price of cancer drugs," said Brenner. She stressed that aspirin would not be "a cure-all, it's only reducing the risk of estrogen positive-breast cancer." Other pluses include the fact that aspirin is inexpensive and relatively non-toxic for most people, though the American Cancer Society does not recommend using aspirin because of its link to gastrointestinal bleeding. "There are risks with aspirin, and there are people for whom aspirin is not indicated," Brenner said. "But they might want to talk to their doctors about this study and whether aspirin is appropriate for them." It's important to remember, however, that aspirin is not a breast cancer preventative. May 07, 2008Women Veterans Health Care Improvement Act of 2008
Last month, Senator Patty Murray introduced the Women Veterans Health Care Improvement Act of 2008 (S 2799), "to expand and improve health care services available to women veterans, especially those serving in Operation Iraqi Freedom and Operation Enduring Freedom, from the Department of Veterans Affairs, and for other purposes." The bill calls for a long-term study of the health of women serving in Iraq, an assessment of barriers for women seeking care at Dept. of Veterans Affairs facilities and of the VA's provision of health services to women, training of VA staff on treating women veterans who have experienced sexual trauma or PTSD. Although reliable estimates of military sexual assault and PTSD among women veterans are difficult to obtain, some authors have suggested that rate of sexual assault is 30% or higher. It also includes measures that would assist with child care while women are being seen by VA providers, and a requirement for VA medical centers to have a full-time women veterans program manager. The bill has been referred to the Senate Committee on Veterans' Affairs, although it is not clear when the committee will consider the legislation. A companion bill (HR 4107) was introduced in the House last November and was referred to the Subcommittee on Military Personnel. May 06, 2008Fat Anti-Bias Campaign
"In an overwhelmingly overweight nation that worships thinness, many describe prejudice against the obese as one of the last socially acceptable biases," writes Lisa Anderson at the Chicago Tribune. "Advocates for the plus-sized, particularly activists in the 'fat acceptance' movement, want obesity to become a category legally protected against discrimination, like religion, race, age and sex. But not everyone agrees." "I think it would help mostly because it would send a message that fat people are equal citizens. It's not in the litigation rates, but the rights consciousness that comes after legislation," said Anna Kirkland, an assistant professor of women's studies and political science at the University of Michigan who is author of the new book, "Fat Rights: Dilemmas of Difference and Personhood," which examines the question of whether weight should be a protected category. The story goes on to discuss a law to ban discrimination against weight and height pending in Massachusetts. Here's the text of House bill 1844 (PDF), sponsored by Rep. Byron Rushing. Rushing has offered similar bills six times in the last 12 years. He told the Trib that last month's public hearing on the bill showed "there is a growing number of people who think this should happen and an even larger number of people who think we should at least be talking about it." Similar anti-discrimination legislation is already in place in Michigan and the District of Columbia, and cities such as San Francisco, Santa Cruz and Madison. "It's not really about litigation, but about taking a stand," said Marilyn Wann, a fat-rights activist who testified at the Boston hearing and helped get San Francisco's law passed in 2000. "I do think when a government says it's not OK to dismiss someone as a person because of weight, that's helpful." Plus: Read Fat People: Please Stop Existing at Big Fat Blog. May 05, 2008Why Isn't Nitrous Oxide Widely Available for Labor Pain Relief in the U.S.?
I was recently pointed to an editorial in the March 2007 issue of the journal Birth which asks, "Nitrous Oxide for Pain in Labor--Why Not in the United States?" You may be familiar with nitrous oxide ("laughing gas") as it is sometimes used during dental procedures, but as this Our Bodies Ourselves piece notes, the gas is often used in other countries as a means to control pain during labor. As the Birth editorial explains, nitrous oxide is self-administered by a woman in labor (primarily for safety reasons), allowing her to obtain a short burst of relief only when needed as an alternative to an epidural. There isn't a tremendous amount of research on nitrous oxide during birth, but a 2002 systematic review highlights some basic information about this technique. The authors note that the gas does not appear to affect the fetus or newborn or depress uterine contractions, although women may experience some lightheadedness and may have a slight delay in pain relief as the gas takes ~50 seconds to achieve its full analgesic effect. They also note that the gas can be both administered and stopped quickly. Most interesting, perhaps, is this assessment of how widely use of nitrous oxide varies from country to country - "By the 1980s, use of nitrous oxide had almost disappeared in the United States. In the United Kingdom, it has been estimated that nitrous oxide is used by approximately 50% to 75% of women and in Finland by approximately 60%. Nitrous oxide is used and widely considered to be safe in many parts of the world including Canada, Australia, and New Zealand, supervised by physicians, nurses, or midwives." It is not entirely clear why this option isn't more readily available in the United States. I'd be interested in hearing from readers as to whether nitrous oxide was available to you in labor - let us know in the comments! If you're in the UK or elsewhere with common use of this option, please share your thoughts as well. Citations for further reading:
May 03, 2008Double Dose: Bush White House - "Where All Good Public Health Protections Go to Die"; Afghanistan's High Maternal Death Rate; The Disney Hypocrisy; Divorce Tied to Professor's Job Loss; Amy Richards on "Opting In"; and More
Federal Agencies Can Now Offer Secret Input on EPA Chemical Reviews: The Washington Post reports on changes the Bush administration has made to Environmental Protection Agency reviews of chemicals -- changes that officials with the Government Accountability Office say will delay scientific assessments of health risks and open the process to politicization. Richard Wiles, executive director of the Environmental Working Group, called the EPA process a "bureaucratic quagmire," adding, "With these rules in place, it's now official: The Bush White House is where all good public health protections go to die." Death in Childbirth a Health Scourge for Afghanistan: Reuters takes a close look at the staggering maternal death rate in Afghanistan, where about 1,600 Afghan women die in childbirth out of every 100,000 live births. "In some of the most remote areas, the death rate is as high as 6,500. In comparison, the average rate in developing countries is 450 and in developed countries it is 9," writes Tan Ee Lyn. "Virtually everyone in Afghanistan can recount a story about a relative dying in childbirth, often from minor complications that can be easily treated with proper medical care." Plus: Read our previous posts on Afghanistan and maternal health -- and how the United States has mismanaged funding and programs intended to improve hospital conditions. The Disney Hyprocrisy: From Slate: Forget Miley Cyrus. Check out Disney's Chinese underwear ad. Just go. Plus: There's a new book out on the sexualization of 'tween girls: "The Lolita Effect," by Gigi Durham, a University of Iowa journalism professor. "I'm criticizing the unhealthy and damaging representations of girls' sexuality, and how the media present girls' sexuality in a way that's tied to their profit motives," said Durham in this release. "The body ideals presented in the media are virtually impossible to attain, but girls don't always realize that, and they'll buy an awful lot of products to try to achieve those bodies. There's endless consumerism built around that." Divorce Leads to Job Loss: So imagine you're a professor and you're going through a divorce. Your college requires that you talk with a staff member to see whether the grounds for divorce meet Biblical standards. If you don't, you'll lose your job. Yep, that's what happened to a popular English professor who has taught at Wheaton College in Illinois for 20 years. From the Chicago Tribune: Many theological conservatives say the New Testament permits divorce only in cases of adultery or desertion. Wheaton requires faculty and staff to sign a faith statement and adhere to standards of conduct in areas including marriage, said Provost Stan Jones. I admit I'm not up on Bible readings, but what about, say, domestic abuse -- along with a host of other very good reasons? Genetic Link to Osteoporosis: "Researchers have identified two common genetic mutations that increase the risk of osteoporosis and related bone fractures, according to a study released Tuesday," reports Reuters. U.S. Federal Funding for HIV/AIDS: The Kaiser Family Foundation has released a new fact sheet on federal funding for HIV/AIDS in the President’s Fiscal Year 2009 budget request, and comparisons over time, with key funding highlights for domestic and global HIV/AIDS programs. It also includes additional information on federal funding for global TB, malaria and other global health efforts. Can I Get A May Day for Immigrant Women's Health?: "May Day, May 1st, has come to hold the promise of rallies for immigrant rights staged across the United States. And this year is no different. But with McCain's more-of-the-same health care plan having just been released, it's a perfect time to focus on why women's reproductive health care must be a crucial part of any discussion about immigration reform," begins Amie Newman's essay at RH Reality Check. Rescue Us From Our Bodies: Here's a nice round-up of responses to Midol's new "Reverse the Curse" campaign. Stop the Mommy Madness: Salon talks with feminist activist Amy Richards, whose new book is titled "Opting In: Having a Child Without Losing Yourself." Plus: Rachel Fudge reviews "Opting In" for Mother Jones. More Mothers Breast-Feed, in First Months at Least: "About 77 percent of new mothers breast-feed their infants at least briefly, the highest rate seen in the United States in more than a decade, according to a government survey released on Wednesday," reports The New York Times. Enthusiasm, however, was tempered. Breast-feeding experts said that they were cheered by the report's numbers but noted that rates of breast-feeding at 6 months of age have remained unchanged and are significantly lower than goals set by government agencies. The most recent C.D.C. survey did not report breast-feeding rates at 6 months because of a lack of data. [...] May 01, 2008Breast Cancer Activism: Standing up for People over Profit
Our Bodies Our Blog has invited the folks at Breast Cancer Action to write monthly guest posts on breast cancer and related issues. We welcome their first entry! by Pauli Ojea In the late 1980s, a group of women in a breast cancer support group decided it was time for change. These women, who met regularly to share information and to support each other through their experiences, felt there was more they could do, more they needed to do. Frustrated by the lack of reliable information about the disease and the lack of support most women with breast cancer received, they wanted to change the situation for all women facing breast cancer. So, in a San Francisco living room in 1990, the women set out to do something about it: They formed Breast Cancer Action (BCA). Their goal was to move breast cancer from an individual woman's private medical crisis to a public health emergency. The founders put their political know-how, passion and courage to work in order to bring national attention to what was then a rarely mentioned issue. Fast-forward to 2008. BCA is now a national education and advocacy organization with 19,000 members, a 10-person staff, and hundreds of activists and volunteers in the United States and abroad. Although breast cancer has received a lot of attention, the problem has not been fixed. And BCA is still here to help change things. Sadly, all but one of the original founders have passed away, but the vision set for the organization almost 20 years ago lives on. BCA continues to work for change on the political and social issues that have a significant impact on this disease. One of BCA's biggest priorities is advocating for more effective, less toxic treatments for breast cancer patients. Central to this work is the role of the FDA -- the agency that can help, or hinder, the adoption of these treatments. There's been a lot of press coverage lately about the FDA's failure to do its job. In addition to concern that the agency is overstretched and under-funded, there are also concerns about the overwhelming influence of the pharmaceutical industry. The impact of this influence can be felt in many ways. For example, drug companies are currently trying to convince the FDA to loosen regulations on off-label marketing of drugs. Off-label means that the drug is being prescribed for a condition for which it has not yet been approved. Although it's legal for a doctor to prescribe drugs off-label, current FDA rules don't allow drugs to be marketed this way, since approval is based on clinical trials for specific uses. But the drug companies now want the right to market drugs to doctors for unapproved uses. Why does this matter? Drug company reps would be able to visit your doctor (perhaps over an expense-account lunch), talk about other problems their drug could be used for (other than those for which it's been approved), and leave behind medical journal articles depicting the drug's benefits in unapproved settings. While such information may seem beneficial, remember that drug companies are often involved in the studies the journals are covering -- sometimes disclosing their involvement; sometimes not. Besides, if there were enough research to clearly demonstrate the safety and efficacy, the drug would be approved for this use. But drug companies are not as comfortable advertising this point. Of course, it's in the drug industry's best interest to see their drugs used for more diseases: More use translates into bigger profits. The example above is just one of the many ways the pharmaceutical industry attempts to get its way at the FDA. BCA has urged the FDA to make the right choice for public health by not loosening regulations on off-label marketing. The FDA will make its decision soon. We need less pharmaceutical company influence in health care decisions, not more. For the FDA to do its job well, and to effectively protect the public's health, the balance of power at the agency needs to shift away from the drug companies and toward the interests of patients. Pauli Ojea is the community organizer at Breast Cancer Action, where she mobilizes people to do something besides worry. To learn how you can join BCA in speaking up for public health over private profit, click here. May 01, 2008Forget Love. What Would You Do for Health Insurance?
According to a new Kaiser Family Foundation poll, 7 percent of Americans said they or someone in their household decided to marry in the last year for healthcare benefits. "It's a small number but a powerful result, because it shows how paying for healthcare is reflected not only in family budgets but in life decisions," said Drew E. Altman, president of the Kaiser Family Foundation. About 60 percents of those who cited health insurance as a marriage factor live in households making less than $50,000 a year, and 40 percent were between the ages of 18 and 34. "We don't know a lot more about them," Mollyann Brodie, who directs Kaiser's opinion research, told the L.A. Times. "Just that they answered that of all the reasons for getting married, [health insurance] was also a reason, was surprising." More from the L.A. Times: On a broader scale, the survey found that healthcare costs outranked housing costs, rising food prices and credit card bills as a source of concern. Twenty-eight percent of those surveyed said they had experienced serious problems because of the cost of healthcare, compared with 29% who had problems getting a good job or a raise. Gasoline prices were the top economic worry, with 44% saying they had serious problems keeping up with increases at the pump. Speaking of presidential candidates, Sen. John McCain this week unveiled his healthcare plan. In doing so, he "rejected calls for universal health coverage and reaffirmed his faith in the economic principles that have guided President Bush for eight years, declaring Tuesday that government's role in health care should be limited to kick-starting a competitive marketplace so people can buy their own insurance," writes Michael D. Shear in the Washington Post. Good luck with that. In a separate story, the L.A. Times reports on the soaring cost of health insurance premiums: Workers with job-based coverage for their families saw earnings rise 3% from 2001 to 2005, while their health insurance premium contribution increased 30%, according to the study by researchers at the State Health Access Data Assistance Center at the University of Minnesota. Making matters worse -- Between 2001 and 2005, more than 30,000 of the 3.6 million private-sector employers offering health insurance as a benefit to workers dropped it. "Squeezed: How Costs for Insuring Families are Outpacing Income," a state-by-state analysis prepared by the State Health Access Data Assistance Center, is available here. April 30, 2008New Study Examines Depression in Women, Including Effects of Abortion and Partner Violence
A new study in BMJ Public Health examines depression in women and the relationship of past abortions to the condition. This new report is particularly interesting because it attempts to control for the effects of sociodemographic factors and considers the women's experiences of intimate partner violence, recognizing that multiple factors may impact a woman's mental health. Although the study focuses on Australian women, it may be of interest to readers in other countries as well due to recent attempts by anti-choice groups to promote the existence of a so-called "post-abortion syndrome," or causal link between abortion and depression, which has thus far been unsupported by the medical evidence. Similar to unsupported and debunked claims of an abortion/breast cancer link, this tactic frames the pro-choice position as anti-women's health, despite the lack of evidence to support that framing. (For background reading, try this commentary in Ms. Magazine and a lengthy discussion of the issue in the New York Times.) In the new study, researchers surveyed Australian women ages 18-23, collecting data on sociodemographic variables, reproductive history, and intimate partner violence. The women also completed depression scales and questions about past diagnosis of depression, with a follow-up survey conducted four years later. Before controlling for other variables, a previous pregnancy termination or having two or more children was associated with an increased risk of depression. However, when the researchers controlled for those other factors, there was no longer an association between abortion and depression, and the increased odds of depression for those with two or more children dropped to be almost insignificant. Further, the authors found that, even after controlling for sociodemographic factors, experiencing intimate partner violence had a significant effect on the odds of depression, suggesting that is violence a more important factor than either abortion or childbearing with regards to women's mental health. Meanwhile, anti-choice advocate Michaelene Fredenburg has started the "Abortion Changes You" website, inviting people to submit their stories of regret and shame. ImNotSorry.net takes a different approach, offering an alternative story-sharing site for women who need a space to say that they are not ashamed of their choices. April 29, 2008Mini-Double Dose: Art, Pain and Illness; Genes and Race Disparity; Through Sickness, Health and Sex Change
There are a number of interesting stories in The New York Times, so let's do a mini-double dose ... Pain as an Art Form: Well's Tara Parker-Pope does a nice job describing how art is used to communicate physical pain, from some of Frida Kahlo's self-portraits (now on exhibit at the Philadelphia Museum of Art) to a new online gallery called the Pain Exhibit. The gallery is the brainchild of Mark Collen, 47, a former insurance salesman who struggled to explain his chronic back pain to a new doctor. "It was only when I started doing art about pain, and physicians saw the art, that they understood what I was going through," Collen said. "Words are limiting, but art elicits an emotional response." Taking it a step further, Collen started soliciting art from pain patients around the world. He teamed up with James Gregory, a 21-year-old college student who suffers from chronic pain following a car accident, and together they created the Pain Exhibit. Parker-Pope writes: Finding ways to communicate pain is essential to patients who are suffering, many of whom don't receive adequate treatment from doctors. In January, Virtual Mentor, the American Medical Association Journal of Ethics, reported that certain groups are less likely to receive adequate pain care. Hispanics are half as likely as whites to receive pain medications in emergency rooms for the same injuries; older women of color have the highest likelihood of being undertreated for cancer pain; and being uneducated is a risk factor for poor pain care in AIDS patients, the journal reported. The art is connecting with medical professionals. The journal of the International Association for the Study of Pain features an image from the exhibit on the cover of its November issue, which focuses on women and pain. Quieting the Demons and Giving Art a Voice: Like sculpture and painting, writing is also a form of expression and release. This review looks at "Madness: A Bipolar Life," a new memoir by Marya Hornbacher, whom writer Abigail Zuger, MD, describes as "a virtuoso writer: humorous, articulate and self-aware. She is also, as she has now documented in two books, incurably mentally ill." Zuger continues: For scientists trying to parse the mystery of brain and mind, she is one more case of the possible link between mental illness and artistic creativity. With all our scans and neurotransmitters, we are not much closer to figuring out that relationship than was Lord Byron, who announced that poets are "all crazy" and left it at that. But effective drugs make the question more urgent now: would Virginia Woolf, medicated, have survived to write her final masterpiece, or would she have spent her extra years happily shopping? Zuger also considers "Poets on Prozac: Mental Illness, Treatment and the Creative Process," edited by Richard M. Berlin, M.D. Essays were solicited from published poets with psychiatric illness. "Most of the 16 contributors are decades older than Ms. Hornbacher, but while they may lack her vivid prose style, they do supply a long-term perspective on the terrain," writes Zuger. Genes Explain Race Disparity in Response to a Heart Drug: This is a fascinating story. Researchers at Washington University and the University of Maryland found that patients who are non-responsive to a beta-blockers used in the treatment of heart failure may be making what amounts to their version of the drug, all the time, due to a gene variant. What's also surprising is that as many as 40 percent of blacks have this altered gene, compared to 2 percent of whites. The website of the journal Nature Medicine published a paper explaining the study. "Something that occurs with a 40 percent frequency is not something that was a blip on the radar screen," said Dr. Gerald W. Dorn, a cardiologist at Washington University and principal investigator for the study. "It must have given a survival advantage." -- Though what that advantage is is still the big unknown. Gina Kolata writes: The discovery raises questions about whom to treat with beta blockers and how to decide, researchers say. But, they add, its implications go beyond heart failure. Through Sickness, Health and Sex Change: Finally, here's a story from the Sunday paper about a married couple in New Jersey who are concerned about the legal status of their relationship, since the male partner underwent a sex change in 2005. The couple, who have three children, are still very much committed to each other. Tina Kelley writes: Massachusetts is the only state to have legalized same-sex marriage, and the Brunners are two women married to each other in New Jersey. As this state (along with Connecticut, Vermont and New Hampshire) confronts challenges over whether its civil unions fulfill the mandate of providing same-sex couples equal rights and benefits, the Brunners offer themselves as Exhibit A on how the nation's dizzying patchwork of marriage laws, which include the domestic partnerships of California and other states, may be out of step with people's lives. And here's another mind-blowing breakdown of the complexities state by state: The Brunners were already married when Donald became Denise. Transsexuals who marry after surgery pose a different set of questions, and there have been a number of custody, probate and other cases with decisions all over the legal map. April 28, 2008On Increasing Rates of Diabetes in Pregnancy
An article set to appear in the May issue of the journal Diabetes Care is garnering widespread media attention today, as it declares that the prevalence of pre-existing diabetes in women who become pregnant has doubled over the past several years. Diabetes can cause serious complications for both women and fetuses during pregnancy. The authors looked at data for women in Southern California who gave birth to a single baby >20 weeks gestation in one hospital system. They looked at how many women had pre-existing or gestational diabetes, and how the prevalence of diabetes changed over time. The authors found that the overall prevalence of pre-existing diabetes more than doubled from 1999 to 2005, from 0.81 to 1.82 women with the condition per 100 births, with younger women and black women experiencing the largest increases. The researchers did not find a similar change in gestational diabetes, which remained fairly stable. CDC data indicates that the prevalence of diabetes has risen across all age groups from 1980 to 2005, so it seems somewhat predictable that as more women have diabetes, more births to diabetic women will occur. An important aspect of this issue is that preconception counseling, careful monitoring and control of glucose levels, and intensive following by healthcare providers is generally recommended for women with diabetes who are or plan to become pregnant. One physician who spoke to the Washington Post about the findings stated that "Control isn't easy to do, because you have to have adequate nutrition and still control your blood sugar." In other words, the issue isn't just about headline-friendly risks to babies, but touches on whether women lack appropriate access to affordable healthcare, healthy nutritious foods, and information about the disease and the ability to monitor it closely. For more information on diabetes and pregnancy, check out this resource from MedlinePlus, and the Diabetic Mommy forum for discussion of the topic with other women. April 27, 2008Double Dose: Illinois Court Rules on Sterilization; Choosy Mothers Choose ... Well, Not This C-Section Story; Fundamentalism Comes Under Public Health Scrutiny; Botox, Body Image and Aging; Coming of Age on Antidepressants; and More
Court Denies Bid to Sterilize Mentally Disabled Woman: "Disability rights advocates and medical ethicists praised a precedent-setting ruling Friday by the Illinois Appellate Court denying a bid to sterilize a mentally disabled woman against her will," reports the Chicago Tribune. The woman's guardian had sought a tubal ligation, but a three-judge panel ruled unanimously that the guardian did not prove sterilization was in the woman's best interest. There are "less intrusive and less psychologically harmful [birth-control] alternatives," read the opinion. "It's extraordinarily significant" because it guarantees the disabled a court hearing, said Katie Watson, a Northwestern University professor who wrote a friend-of-the-court brief in the case on behalf of about two dozen medical ethicists. Choosy Mothers Choose ... Well, Not This C-Section Story: Time magazine's "Choosy Mothers Choose Caesareans" is problematic on multiple levels -- but mainly for overplaying the role of women requesting elective c-sections as the reason being the skyrocketing caesarean rate, and downplaying the risks involved. Lucinda Marshall rocks with a great response. Plus: For more information, read "Maternal Request for Cesarean Delivery: Myth or Reality?" -- a summary of the latest research and articles compiled by Our Bodies Ourselves. Fundamentalism Comes Under Public Health Scrutiny: From Women's eNews: "Amid the growing influence of fundamentalism around the world, Asian researchers say women in almost any affected religion -- Christian, Muslim or Hindu -- pay the price in eroded health and safety." Read the story by Swapna Majumdar, a journalist based in New Delhi. Take Two on Time Off: "This year marks the 15th anniversary of the landmark Family and Medical Leave Act, which made it possible for many workers to take unpaid job-protected time off to care for their newborn children or sick relatives," writes Nancy Trejos at the Washington Post. "But instead of celebrating, workers' rights advocates and the Bush administration are battling over what would be the most sweeping revisions ever to the law." Trejos notes that a "fierce debate" has been sparked by some proposed changes, which have yielded more than 4,000 public comments: Under proposals being considered by the Labor Department, workers would have to tell their bosses in advance when they take nonemergency leave, instead of being able to wait until two days after they left. They would have to undergo "fitness-for-duty" evaluations if they took intermittent leave for medical reasons and wanted to return to physically demanding jobs. To prove that they had a "serious health condition," they would have to visit a health-care provider at least twice within a month of falling ill. What's more, employers would have the right to contact health-care providers who authorized leave. Botox and Disrespect of Aging: "The 2,775,176 Botox treatments in 2007, at a cost of more than $1 billion dollars neatly expresses the desperation some people feel about physical signs of aging," writes Ronni Bennett, before going on to discuss recent studies on the potential dangers of Botox and the FDA's make-your-own-personal-judgment advice to consumers. Coming of Age on Antidepressants: Writing in The New York Times, Richard A. Friedman, MD, reflects on the remarks of a 31-year-old patient who has been treated for depression since she was a teen: “I've grown up on medication," she said. "I don't have a sense of who I really am without it." The patient credited the medication with saving her life, "but now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity." Friedman continues: Her experience is far from unique. Since their emergence in the late 1980s, serotonin reuptake inhibitors like Prozac and Zoloft have become some of the most widely prescribed drugs in the world, for depressed teenagers as well as adults. Because depression is often a chronic, recurring illness, there are certain to be many young people, like Julie, who are coming of age on these newer antidepressants. Plus: Friedman and Norman Rosenthal, MD, were both guests on NPR's "Talk of the Nation" on Thursday, discussing the physical and psychological effects of taking antidepressants long-term. Ireland Releases Study on Menopause: Ireland's Minister for Health, Mary Harney, published "Menopause and Me," hailed as the largest ever study in Ireland on awareness, attitudes and experiences of menopause, according to The Irish Times. Ireland's Women’s Health Council carried out the study, which is available online here. Performance Artist Killed on Peace Trip: An Italian performance artist, Pippa Bacca, 33, was raped and killed by a driver who offered her a ride just three weeks into a hitchhiking trip from Italy to the Balkans to the Middle East. Bacca and her friend, Silvia Moro, 37, both wore wedding dresses as part of their "Brides on Tour" project, created to send a message of peace and "marriage between different peoples and nations." Elisabetta Povoledo writes in The New York Times: The performance piece, a trip through nearly a dozen countries in the Balkans and the Middle East, many of them ravaged by war recently, was meant to underscore that "by overcoming differences and lowering the level of conflict," individuals and cultures could come together, Ms. Moro said in a telephone interview. "Meeting people was the key." April 26, 2008One Word: Plastic
Not since "The Graduate" gave career advice that became a pop-culture shortcut for artificiality has so much attention been paid to plastic. Last week, the National Toxicology Program released a draft report on bisphenol A, or BPA, a chemical used in hard, clear plastic, such as Nalgene and baby bottles, as well as in the lining of baby formula containers and canned foods. Studies in animals have linked it to hormonal changes, and the report acknowledged "some concern" that BPA may affect neural and behavioral development "in fetuses, infants, and children at current human exposures." The report "signaled a turning point in the government's position on bisphenol A, or BPA, a chemical so ubiquitous in the United States that it has been detected in the urine of 93 percent of the population over 6 years of age," Lyndsey Layton wrote in the Washington Post, though it only called for more research into the health effects. "What we've got is a warning, a signal, of some concerns," said Mike Shelby, director of the Center for the Evaluation of Risks to Human Reproduction, who oversaw the report. "We could not dismiss the possibility that similar or related effects might occur in humans." Manufacturers of BPA were less than impressed. The American Chemistry Council, which represents manufacturers, said the report "affirms that there are no serious or high level concerns for adverse effects of bisphenol on human reproduction and development." Here's some more detail on the decision: The toxicology panel used a five-level rating system, ranging from serious concern to negligible concern. It labeled the possible cancer risk of BPA as "some concern," in the middle of the scale. There was not enough scientific evidence to rank it as a "concern" or a "serious concern," Shelby said. Kinda makes you not want to trust the government on this one. Meanwhile, our neighbors to the north are moving more swiftly on BPA. Health Canada, the main government health department, declared BPA a "toxic chemical" and the Canadian government moved to ban polycarbonate infant bottles. The health minister, Tony Clement, told reporters that after reviewing 150 research papers on B.P.A. and conducting its own studies, his department concluded that the chemical posed the most risk for newborns and children up to the age of 18 months. The minister said that animal studies suggest "there will be behavioral and neural symptoms later in life." The Canadian government found no current risk to adults but said it would begin monitoring BPA exposure of 5,000 people between now and 2009, with possible additional action to come if such research indicates any danger. When the U.S. report by the National Toxicology Program was released, a spokeswoman for the International Formula Council, which represents baby food makers, said, according to the AP, "'the overwhelming scientific evidence supports the safety' of bisphenol, adding that no foreign governments have restricted or banned its use." What bad timing. Since that's no longer the case, the IFC will have to come up with another excuse not to prioritize the health of infants and young children. For more in-depth reading on the health concerns and scientific debate around BPA, check out "The Plastics Revolution," published in the Washington Post earlier this week. The author, Ranit Mishori, a family physician and faculty member at the Georgetown University School of Medicine, also looks at the debate over phthalates -- chemical compounds that improve the longevity, durability and flexibility of plastic. In animal studies, these compounds have been linked to cancers and genital abnormalities, especially in males. Again, the Unites States lags behind other countries, as phthalates are already banned in the manufacture of toys in most European countries. California took action on its own, implementing a ban that goes into effect in 2009 on some phthalates found in toys and teethers. A dozen other states are considering similar bans. But it's not as easy as banning items that children like to put in their mouths. Phthlates are also found in commonly used personal care products, including shampoos and deodorants and perfumes -- for more info., see our previous post on cosmetics and phthalates. For a useful Q&A on the health risk related to BPA and tips on lowering exposure, read Tara Parker-Pope's column, "A Hard Plastic is Raising Hard Questions." I have a collection of Nalgene bottles and have been slowly transitioning away from my much beloved, wide-mouth hiking staple. But Nalgene isn't wasting any more time (or dollars): The company has decided to turn to other plastics that do not contain BPA. April 24, 2008Obstacles to Female Condom Distribution Outlined in New Report
A new report commissioned by the Center for Health and Gender Equity (CHANGE) blames "bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms" for delaying the expansion of U.S.-funded female condom distribution efforts. But the biggest deterrent -- for both male and female condoms -- lies within U.S. global policy concerning HIV prevention. The report, "Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid," takes to task the U.S. Office of the Global AIDS Coordinator, which prioritizes condom promotion programs under the President’s Emergency Plan for AIDS Relief (PEPFAR) only for "high-risk persons." Also damaging is the congressionally mandated requirement that PEPFAR spend 33 percent of all HIV prevention funds on abstinence-until-marriage programs, which funnel money toward programs that only promote abstinence and fidelity as means of preventing HIV. Congress reauthorized PEPFAR earlier this month. Policy and news updates are available through PEPFAR Watch, also sponsored by CHANGE. "Saving Lives Now" is available for free at PreventionNow.net (download PDF), a global campaign to expand access to female condoms. CHANGE and its U.S. partners work with existing female condom campaigns in other countries such as Argentina, Ghana, and Zambia. Female condoms account for just 0.2 percent of total global condom supply. The report found that female condoms are available in 108 countries, but they are not readily accessible in most countries. The United States has supplied female condoms to 30 countries in the past decade and to 16 countries in 2007. Nearly 26 million female condoms were distributed worldwide in 2007, compared to 11 billion male condoms. "It is distressing that women make up half of those infected by HIV and policy makers are refusing to provide women with the tools they need to negotiate safer sex," said Serra Sippel, CHANGE executive director. "The U.S. and other donors must increase comprehensive funding for the purchase, distribution and programming of female condoms to ensure that women and men have access to female condoms and know how to use them." FINDING: U.S. agencies responsible for female condom programming and procurement do not have polices that promote the integration of female condoms into HIV prevention and family planning programs. Whether the U.S. procures female condoms in a given country is highly dependent on the personal biases of USAID mission staff. Plus: Here's a post from last year on efforts to redesign the female condom and problems with raising money in the United States for the clinical trials required for FDA approval. April 23, 2008Our Bodies, Ourselves: Pregnancy and Birth Featured on NBC10
OBOS's own Judy Norsigian was featured yesterday on Philadelphia's 10! show (a production of the local NBC affiliate) in an excellent segment on the new book, Our Bodies, Ourselves: Pregnancy and Birth. You can view the six minute video here. In the segment, Judy discusses the origins of the book and topics including prenatal testing, fetal monitoring, and pain relief in labor. A transcript is also provided. Kudos to Judy and thanks to NBC 10 for bringing the book to the attention of their audience. If you'd like to hear more about the book and OBOS in person, don't forget to check out our calendar of events! Judy will be in Portland, Seattle, San Francisco and LA soon at a variety of book events and panel discussions, with several other cities to follow. April 22, 2008Mortality Inequality: Life Expectancy Declines for Some U.S. Women
The Washington Post has a front-page story today that's a shocker: Lfe expectancy for some U.S. women is on the decline, and the data points to a growing inequality between the best-off and worst-off counties. Here's the rundown: In nearly 1,000 counties that together are home to about 12 percent of the nation's women, life expectancy is now shorter than it was in the early 1980s, according to a study published today. There was some decline noted for men, too, but the decline was smaller (affecting 4 percent of males) and limited to fewer areas of the country. According to researchers, higher HIV/AIDS and homicide deaths contributed substantially to the life expectancy decline for men, but this was not the case for women. The news comes from this study (PDF) published in PLoS Medicine, an open-access journal of the Public Library of Science. The study is based on mortality statistics from the National Center for Health Statistics (NCHS) and population data from the U.S. Census, gathered for the years 1961-1999, the last year data was available from the NCHS. Overall, the average life expectancy nationwide increased during that period from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women. (It's worthwhile noting, as this story does, that life expectancy is "not a direct measure of how long people live," but is "a prediction of how long the average person would live if the death rates at the time of his or her birth lasted a lifetime.") Between 1961 to 1983, life expectancy kept going up everywhere, mostly because the death rate from heart attacks kept going down due to better prevention and improvements in medicine. But then researchers noticed a change: By the early 1980s, however, the rapid gains were coming to an end. The low-hanging fruit on the tree of heart-attack prevention and treatment had been picked. Further strides tended to happen mostly in places where people were already healthy and long-lived. Precisely why these 1,000 counties are the most affected is something for further study. Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study, tells the Post that it "would be a reasonably obvious strategy" to target them for aggressive public health campaigns. Campaigns are a positive step, but I wonder whether this news will spark more than well-intentioned programs. Addressing health inequalities in poor communities means addressing everything from access to medical care to access to grocery stores stocked with fresh fruit and vegetables. It means providing real economic opportunity. Maybe the fact that the life expectancy decline is pretty much to the United States -- save for some African countries stricken by the AIDS epidemic, or Russia following collapse of the Soviet Union -- will make this country's shocking health disparities an issue in the presidential campaign, right up there with, say, flag pins. April 22, 2008Belly Hair, Check; Sex Drive, Not So Much
This just in: "Women who spray testosterone on their stomach to raise their sex drive may not see much benefit — unless they also want to grow hair on their belly," reports The New York Times in today's Science section. The short report is based on a new study, "Safety and Efficacy of a Testosterone Metered-Dose Transdermal Spray for Treating Decreased Sexual Satisfaction in Premenopausal Women," published in the Annals of Internal Medicine. The randomized study included 261 women age 35 to 46 years who reported decreased sexual satisfaction and had low testosterone levels. From the Times: At the start the study, the women reported having four to five sexual encounters a month, with an average of 1.4 described as satisfactory. After 16 weeks, the women in all the groups reported a somewhat better sex life, although the increase was statistically meaningful only for the group that received the middle dose of testosterone. Unwanted hair growth where the spray was placed was fairly common. April 21, 2008What's the Truth About Teen Pregnancy?
You may have seen recent headlines such as "US teen pregnancy rate near historic low" and been somewhat confused (I certainly was). After all, didn't the CDC just announce that teen pregnancy rates were going up? A Dec 7, 2007 CDC press release entitled "Teen Birth Rate Rises for First Time in 14 Years" stated that "The teen birth rate in the United States rose in 2006 for the first time since 1991, and unmarried childbearing also rose significantly, according to preliminary birth statistics." The two reports focus on slightly different things - teen pregnancies vs. teen births. The new report notes that the teen pregnancy rate was 72.2 per 1,000 ages 15-19 in 2004. The 2006 report indicates that the teen birth rate has increased to 41.9 births per 1,000, but doesn't provide an overall teen pregnancy rate. These are difficult to compare easily, as not all pregnancies result in births. We know, then, that births to teenagers increased in 2006, but not how the actual pregnancy rate changed. The teen pregnancy report shows a historic trend of both birth and abortion rates declining alongside pregnancy rates. Another difference between the two reports is the time period covered. The report cited by the most recent CDC press release ("Pregnancy Rate Drops for U.S. Women Under Age 25") actually states: "Pregnancy rates for females under age 25, including teenagers, in the United States declined in 2004 compared to 1990." This most recent report stops at 2004, when teen pregnancy rates were at their lowest point since data began being collected in 1976, falling steadily from a record high around 1990. It does not include 2006 data on teen pregnancies or births, when we know at least that the teen birth rate had increased. What difference does it make? If you only looked at the most recent, "teen pregnancies down!" reports, you might have a different impression with regards to sex education, contraception availability, and related policy than if you also looked at the 2006 data and asked why an increase occurred. Although we don't yet know if that increase represents the beginning or a trend or a mere blip, it's important to remember that one report does not always provide a complete picture. |
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