Wednesday, August 31, 2005

Safety Alert for Vanderbilt-Area Women

Vanderbilt Security has issued alerts for two recent incidents - one rape and one simple assault. On August 26, a student was raped: "A man in a white vehicle asked the student, who was in front of the Kappa Alpha House at 201 24th Avenue South, if she needed a ride. The student got into the car thinking it was a taxi. The student was taken to an off campus location where she was sexually assaulted."
Suspect Description: Male black, in his 30s.
Vehicle description: White 4 door car, possibly a taxi cab"

On August 29, a student was also assaulted by a taxi driver. "The student stated that she was walking on 24th Avenue between Vanderbilt Place and Kensington Place when a taxi cab driver offered her a ride. When the student attempted to get into the back of the vehicle, the driver locked the back doors and told her to get into the front seat... During the trip, the student said the driver touched her neck and arm and made inappropriate comments. After arriving at the off campus destination and leaving the vehicle, the student said the suspect blocked her path with his vehicle multiple times."
Suspect Description: Male, black or person of Indian descent, late 20s or early 30s, 6'0", 180 pounds, slender build, slender face, short black hair ("spikey" in the front), brown eyes, dark complexion, last seen wearing a short sleeve shirt. In addition, the driver spoke with an international accent.
Vehicle Description: White 4 door Sedan. The vehicle had a "Taxi" style light on top, a pay meter in the front of the vehicle, with possible a dark blue interior.

If you have any information on these incidents, you are asked to contact VU POLICE AT 32(2-2745) or call crime stoppers as 74-CRIME (742-7463) if you wish to remain anonymous.

Resources:
  • MedlinePlus has a good page of resources for information on rape and sexual assault.
  • "What to do if you're raped" - from FamilyDoctor.org
  • Searchable directory of emergency contraception providers
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  • Director of FDA's Office of Women's Health resigns

    Susan Wood (Director of the FDA's Office of Women's Health) resigned on Wednesday in reaction to the agency's delay in making a decision about OTC status for the Plan B emergency contraceptive. According to the NYTimes, Wood stated, "I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled."
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    Saturday, August 27, 2005

    Refusing VBAC for Liability Reasons

    Via Kevin, MD, I learned about this story in USAToday titled "Battle lines drawn over C-sections." The piece describes women who were not allowed to attempt vaginal birth after C-section due to the doctor/hospital's concerns about litigation if uterine rupture were to occur. For example, "In Oklahoma, most OB/GYNs won't allow patients to attempt a VBAC because their malpractice insurance no longer will cover claims resulting from such births."

    "And some women, such as Barbara Roebuck, never bother going to the hospital. Roebuck, 37, delivered four babies vaginally before requiring a C-section for her fifth, who was breech. Pregnant with her sixth, she says she saw four doctors in a futile search for one who would let her try a VBAC. Every one of them said: 'Hospital policy. You don't have a choice,' Roebuck recalls." According to the story, some women were apparently encouraged to temporarily relocate in order to have the choice of how to give birth.

    As the article mentions, the incidence of perinatal death due to uterine rupture during VBAC seems to be very low, about 1.5/10,000. A very detailed evidence report on the topic is available here. It seems that this should be evaluated on a woman-by-woman basis, rather than forcing surgery on women due to potential litigation issues.

    Some resources:
  • Vaginal Birth After C-Section Health Decision Guide - from MayoClinic.com
  • Vaginal Birth After Cesarean Delivery - from UpToDate Patient Information
  • Birth Choices After Cesarean Section - from KidsHealth Medical Research News for Parents
  • Researchers Advise Against Attempting VBACs in Birth Centers - press release from the American College of Obstetrics and Gynecology
  • Vaginal Birth after Cesarean - from the American Pregnancy Association, outlines risks of repeast Cesarean vs. VBAC.

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  • Commenting Open on FDA Plan B Decision

    I should point out that, regarding making emergency contraception available OTC, the issue they are currently accepting public comment on is "Circumstances Under Which an Active Ingredient May Be Simultaneously Marketed in Both a Prescription Drug Product and an Over-The-Counter Drug Product." You may submit comments on that issue here. I reasonably sure that this particular issue is not one that folks on either side of the debate actually care about; the docket includes the questions of whether age-restricted OTC status could be enforced, and whether the OTC and prescription drug could be marketed in the same packaging. However, I would encourage you to complete a response addressing these concerns if the end result of making EC more accessible to women is one that you care about.
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    Friday, August 26, 2005

    FDA Delays Emergency Contraception Decision

    FDA Commissioner Lester Crawford released a statement today indicating that the agency would delay a decision on Barr Laboratories' application to make Plan B emergency contraceptive availalble over the counter to women 16 years of age or older. The rationale for the decision is that "What we are saying today is that the Agency is unable at this time to reach a decision on the approvability of the application because of these unresolved regulatory and policy issues that relate to the application we were asked to evaluate," the regulatory issues being whether a drug can have both prescription and over the counter status at the same time, whether the two could be "marketed in a single package," and how the limitation would be enforced.

    I'm not sure why these are such big issues - we enforce age limits on other products through carding, and the same-package-for-different-status problem seems somewhat trivial. As for being both OTC and prescription, the release doesn't really explain the rationale for that being a problem, except that "If it needed a prescription for one group of people, then it needed a prescription for all people. That was FDA’s practice for a very long time." Barr submitted the new application to exclude younger women because their initial application was rejected due to the FDA's concern over a lack of safety data for the drug in younger women. Barr released their own response to the latest decision here. CNN also covers the story with varying reactions.

    The FDA states that there will be at least a 60-day delay in order to receive public comments: "We are beginning a process that will address the regulatory questions today, but we believe we can only decide these issues in an open, public process. Through this process, all interested parties can weigh in on the questions of whether a drug may be both prescription and over the counter based on uses by different subpopulations and whether the prescription and over the counter versions of the drug may be marketed in a single package." Information on submitting comments is available as a PDF at http://www.fda.gov/bbs/topics/news/2005/cd0584.pdf FDA does have an online commenting feature, but todays docket isn't loaded yet. I'll update this post with the link when commenting is available on this issue.
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    Happy Birthday, Right to Vote!

    Today marks the 85th anniversary of the day Secretary of State Bainbridge Colby certified the ratification of the 19th Amendment to the Constitution, thereby giving women the right to vote. Information and document images here and here. Although not strictly a women's health issue, voting is ever-important as women's health issues continue to be politicized. To celebrate the day, I share with you this story:

    One of my clearest, fondest memories of my Korean Grandmother is being allowed to go in a voting booth with her when I was barely tall enough to see over the ballot options and buttons. It was a pleasant day outside, voting took place in a public school on a hill, and I remember excitedly stepping into the booth with her and having the curtain pulled around us. Grandma then cast her vote, and off we went, but it didn't seem at all anti-climatic. It was exciting, and also something that had to be done. There were many other times during my childhood when I was loaded up in the car, because "we have to take Grandma to vote." When she was born in 1926, women had only had the right to vote for 6 years. I was stunned to realize that one of my great-grandmothers had turned 19 before women were allowed to vote. We see the old photos and think the suffrage movement was something "a really long time ago," but I think most of us forget that we may have known women in our lives who were not always legally entitled to vote.

    I don't doubt that those early trips to the voting booth contributed to my lingering interest in all things political, and the fact that I have never missed an opportunity to vote in a presidential election (something unusual for my age bracket). I don't remember who she voted for that day, but the message certainly stayed with me.

    I encourage you all to become more informed about politics, particularly issues that affect your body and health, and get out there and vote. It wasn't so long ago that the women in our families didn't have that choice.

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    Thursday, August 25, 2005

    Timken High School Ruminations

    The Canton Repository carried an opinion piece on Sunday providing the revelation that 65 (13.3%) of Timken High School's (Canton,OH) 490 female students are pregnant. The piece provided some additional statistics: "According to the Canton Health Department, through July, 104 of 586 babies born to Canton residents in Aultman Hospital and Mercy Medical Center — the county’s largest hospitals — had mothers between 11 and 19. That’s nearly 18 percent, or three times the total number of babies born at the same hospitals to teen parents living elsewhere in Stark County and beyond." Local folks took up discussion here. The piece contained the line, "Suspects range from movies, TV and video games to lazy parents and lax discipline." The blogosphere elsewhere and talk radio had a good chuckle about how it was really sex that was getting these girls pregnant, and isn't it funny that their school mascot is the Trojans? Har, har, move along now...

    Ah, but then there was time for the story to sink in, and your friendly women's health blogger still has some questions:

    1) Who released this story, and why? This is not a tinfoil hat question, I'm just genuinely curious why a school district (if they released the info) would put out this kind of story while not providing any information on how a future three-pronged program "addressing pregnancy, prevention and parenting" will work. If I were in charge of the school, I'd have a fully researched and planned program, and then put out the story as, "Pregnancy rates have been unusually high, and we are hoping to improve the futures of our female students by doing X, Y, and Z, which have shown to make dramatic improvements in A and B."

    2) Is this an unusual percentage for the school, or are pregnancy rates typically this high? A little trend data would provide some context. According to Stark County health department data for 2003-04, the rate of births to teen mothers of Canton in 2001 was 42.7 per 1,000, while the county rate was 20.3. The rate of births to teen mothers with no 1st trimester prenatal care was 304.5 for Canton, and the infant and neonatal death rates are also higher than for the county.

    3) Is there anything that would provide some clues as to why Canton girls are getting pregnant at a much higher rate than those in the rest of the county? Are there socioeconomic factors that play into the equation? What kind of sex ed is provided at Timken, and how is the rest of the county doing it differently?

    4) Is there any data on the rate of sexually transmitted infections in young girls in Canton? I can only assume that if they're not using protection to prevent pregnancy, they're not using it to prevent STDs, either.

    5) Do these girls have access to health care coverage or reduced cost services that will ensure healthy pregnancies and births?

    6) Are there any existing support services to help these girls stay in school? My own high school provided a daycare service, through which girls interested in becoming childcare workers could get hands on training, and teenage mothers could have the resources to continue on and earn their diplomas.

    7) Can we count out the media influence factor, given the seemingly extreme localization of the higher pregnancy rate at Timken, assuming that girls at other schools had the same opportunities to be exposed to the same media?

    As this story sunk in, I thought of course about the implications for these girls' education and poverty status. The thing that really struck me, however, was the lack of real information on what the school was doing/teaching, how that differs from other areas of the county with lower pregnancy rates, whether this is normal for the school, etc. It seemed that this story went for the sensational rather than providing the full story, which I'm sure most of you aren't surprised by. It seems that we could try a little harder when reporting this type of news though, and accompany it with less media-blaming and har har-ing about how sex causes pregnancy. I'm fairly sure these girls knew that, so what is going wrong at Timken, and now what?
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    Wednesday, August 24, 2005

    Countdown to FDA Decision on EC

    I was reminded via email today that a decision is expected on 9/1 regarding whether emergency contraception drug Plan B will be made available over the counter. I couldn't find the issue in the list of FDA-related items open to public comment, or other pre-decision press on the FDA website. If you feel compelled to send a comment, the FDA's contact information is available here. I'll have information on the decision as soon as it is released.
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    Sometimes you just have to laugh

    The New York Times published a piece titled "A Perilous Journey from Delivery Room to Bedroom," in which an MD describes the men he treats who confess having trouble being attracted to their wives after witnessing them in the act of childbirth. The article suggests that some of these men are suffering from post-traumatic stress disorder, and delivers such gems as "They seem to have trouble seeing them as sexual beings after seeing them make babies" and "Women may want to consider the risks as they invite their partners to watch them bring new life into the world. For some of the passion that binds them together may leave their lives at the very same time." Lovely.

    A lengthy discussion of this article has already gone on over at BitchPhD. My contribution? An open letter to the Extraordinary Husband, in anticipation of the day he might feel all traumatized and weird over a thing he will have known was coming for a whole 3/4 of a year:

    Dear EH,
    Here's the deal. One day, you and I might want to get together and make some babies. On the day the delivery occurs, you are going to be there in the room with me, and I'm not having any of this hiding behind my shoulders garbage. In fact, the chances of my giving birth in the standard flat-on-my-back position are pretty slim. There may be squatting, standing, walking, jumping, or assorted special implements involved, so your shot at staying in one place and avoiding the view is likewise pretty slim. My mom will be there, and everybody else we know has an open invitation as well. You and my mom have both seen all the parts I have to offer, so you'll be fine, and you should count your blessings if I don't have somebody there live-blogging it all. If I'm going to do this thing, and probably sans pain-relieving drugs, you can bet your behind that I'm going to have an audience, and I expect a hearty slap on the back and the exclamation, "You really rocked that pushing, honey!" Suck it up, kiddo, it's going to be messy in there.
    Love,
    The Cheeky Gyno-Blogger

    Okay, so this is not the best representative post for a professional medical librarian-in-training. Seriously, though, women's health issues are so often fraught with the perils of confusing information, missing data, and/or political agendas, sometimes you just have to laugh.
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    Monday, August 22, 2005

    Male Contraception - is there a market for it?

    Morning Edition had a piece today on forms of contraception for men that are currently in development, involving the man receiving testosterone shots. Here's another story on the topic, and a non-hormonal option for men.

    My question is this: is there even a market for this? Women - would you give up your own methods of birth control and let the man be responsible? Men - are you even interested in being responsible for contraception? In some ways, this seems like a boon to single folks, if both partners are on contraceptives and can therefore further reduce the risk of pregnancy. However, I'm wondering if most women would insist on their own methods no matter what the men told them about their latest injection. I'm certain that I would. What do you think?
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    Sunday, August 21, 2005

    How is your hospital performing?

    The New York Tiimes has an article today titled, "Hospitals are Uneven on Basics," which reviews how Connecticut hospitals are performing on basic care measures, such as providing appropriate treatment to heart attack patients. This information comes from a Department of Health and Human Services resource called Hospital Compare, which can be used to see how frequently hospitals across the nation (including TN) provide what is considered the standard of care.

    To use the site, you will select your location, then be taken through a few screens to select the hospitals you want to compare and the areas of care (heart attack, heart failure, and/or pneumonia) and treatments you want to look at. The results will also tell you why each measure/treatment is considered important. A couple of notes: a lot of data is missing for some of the Nashville hospitals (they're either not reporting data, or the sample is too small to draw conclusions), and the site doesn't work perfectly in browsers for Mac. Additionally, I haven't spent enough time with the detailed data to understand how reporting methods may affect the results, so use at your own risk. I would encourage you to look at all the measures, as I have omitted those for pneumonia. I selected Nashville, all listed hospitals, and all areas of care and treatments to obtain the following results, focusing on heart-related statistics because heart diseases are the leading cause of death in the US.

  • % of heart attack patients given aspirin at arrival: Baptist 98%; Skyline 98%; Centennial 97%; Southern Hills 97%; St Thomas 97%; Vanderbilt 93%; National Average 91%; TN Avg 87%.
  • % of heart attack patients given aspirin at discharge: Vanderbilt 98%; Baptist 96%; St Thomas 96%; Skyline 89%; Centennial 86%; Southern Hills 70%; National Avg 86%; TN Avg 77%.
  • % of heart attack patients given beta blocker at arrival: Skyline 100%; Baptist 96%; Vanderbilt 92%; St Thomas 86%; Centennial 84%; Southern Hills 80%; Nat'l Avg 83%; TN Avg 76%.
  • % of heart attack patients given beta blocker at discharge: Skyline 100%; Baptist 97%; Vanderbilt 94%; Centennial 88%; St Thomas 86%; Southern Hills 84%; Nat'l Avg 84%; TN Avg 74%.
  • % of heart failure patients given smoking cessation advice/counseling: Centennial 94%; St Thomas 81%; Vanderbilt 79%; Baptist 60%; Nat'l Avg 65%; TN Avg 70%.
  • % of heart failure patients given discharge instructions: Skyline 88%; Centennial 73%; Vanderbilt 70%; St Thomas 59%; Baptist 46%; Southern Hills 44%; Nat'l Avg 45%; TN Avg 49%.

    Links:
    MedlinePlus resources on heart attack
    MedlinePlus resources on heart failure
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  • Friday, August 19, 2005

    Sexual Abuse: Thoughts and Resources

    Nashville bloggers have been having a conversation over the past couple of days about sexual assault and disparities in attitudes based on two cases, one involving an older man molesting a girl, and the other a young female teacher molesting a male student. The two offenders received drastically different sentences. Hard Right's blogger started a fury with his comments, which included thoughts such as "I wouldn't want to live in a world where a little girl's sexual purity was not more treasured than a little boy's," and the assertion that if he had a boy or girl molested by a man he would "get a gun," but if they were molested by a woman, he would "get a lawyer." Aunt B. had some compelling comments, as usual. A couple of things are still bothering me:

    1) The double-standard of "treasuring" girls' "sexual purity" more than boys' troubles me. I think there is a slight implication there that girls' bodies are something to be guarded by society, then given away only when deemed appropriate (an odd form of objectification), whereas boys are seen as autonomous and capable of their own decision-making even as young teens.

    2) I wonder if this double standard in attitude and punishment is part of a contiuum of fetishization of young girls' sexuality, and if the emphasis on the "specialness" of that sexuality contributes to the attitudes of sexual predators.

    3) I also wonder if this seeming double standard contributes to under-reporting of sexual assaults. If you, as a male child, knew that your father/protector would "get a gun" if your sister were raped by a man, but only "get a lawyer" if you were raped by a woman, would you be less likely to feel that the offense against you was taken seriously by society, and less likely to report it? Are we devaluing the experiences of both boys and girls molested by women, and sending a subtle message that we don't take it as seriously if there isn't penile penetration? (and does this mean that we think penile penetration is the only "legitimate" form of sex/rape?) Why would we ignore the violence and violation of other forms of penetrative assualt?

    4) I think Brittney brought this up, but the different punishments ignore the power dynamic that is a major basis for statutory rape laws, as well as sexual harrassment laws. Regardless of how "willing" a youngster might seem, the power a teacher or boss has over that individual makes it unacceptable to pursue sexual activity with an underling, be that young person or employee. We also find that 13 year olds are unable to legally drive, be informed enough to vote, or make their own medical decisions, whether they're male or female, so it seems that laws stating that they are unable to truly give informed consent for sex should be applied to young men and women equally.

    More questions than answers, I know. I really thought about staying out of this conversation, but I was surprised by some of the attitudes and statements, so I wanted to address it. My hope is that ALL young victims of sexual assault can feel that what happened to them is taken seriously, regardless of whether they are male or female, and we as adults can have the sense to value and deal with their needs equally. I think having this type of dialogue is necessary in finding our own thoughts and improving the health of all people.

    That said, here are some resources on sexual assault:
  • MedlinePlus page on child sexual abuse
  • Signs of sexual exploitation in children
  • Understanding child sexual abuse - from the American Psychological Association
  • Myths about male sexual victimization
  • Parenting the sexually abused child
  • Rape, Abuse and Incest National Network - 24-hour hotline is 1-800-656-HOPE
  • Tennessee Coalition Against Domestic and Sexual Violence
  • Tuesday, August 16, 2005

    CT Scans for Lung Cancer, part 2

    The New York Times has an article today called "What an Extra Eye on Cancer Can Do for You," which discusses CT scans for lung cancer screening, and states that the United States Preventive Services Task Force has refused to endorse the method of screening. The article explains, "Before any screening method is endorsed by the task force and covered by insurers, including Medicare, it must be shown to be both safe and beneficial, and the benefits must outweigh risks. The main concern is that no study has yet proved that detecting early lung cancers with CT scans improves long-term survival." The piece also indicates that false-positive rates from the scans can be from 3%-50%, although they do not cite the studies that produced these findings. The USPSTF's recommendation statement elaborates on the concerns and insufficient evidence regarding the potential benefits and risks for approving the procedure.

    On an unrelated note, why don't online news articles such as the NYTimes piece provide these links (such as to the USPSTF) themselves? I know that newspaper articles don't typically provide a bibliography of sources, but would it be so hard, if you already have the resources to write your article, to link to the agencies and studies? Research findings are so often oversimplified in news articles, it would be nice to have pointer to the original source.
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    Sunday, August 14, 2005

    I think that I shall never see...

    labia that need surgery.

    Labioplasty (or labiaplasty) is a cosmetic surgery procedure used to reduce the size of the labia minora. In some cases, this procedure can be used to reduce the labia for women with abnormalities that cause discomfort, and apparently it was originally performed mostly on sex workers and transexuals. However, a Google search will reveal that this procedure is promoted to women by surgeons to produce a "sleeker, thinner, more comfortable, and more appealing size and shape," as one site stated, or "younger." Great, now even parts only displayed if I want them to be need to be youthful, sleek and thin. I would suggest that you do NOT Google this at work, as just about every site I found proudly displays shaved, spread-eagle crotch shots demonstrating the before and after right up front on their home pages. One thing that is striking is how, in the before shots, women look different, like women do. The after shots are all virtually indistinguishable from one another - now your girl stuff must be conformist, too!

    Here's an overview of the procedure; if you're so inclined, you can pay $1500-$3000 for the privilege of being more symmetrical. I really just cannot conceive of why someone would do this for "cosmetic" reasons. My take is that if your partner can't handle a little asymmetry or uniqueness there, there are issues that a couple thousand dollars won't or shouldn't fix. This article quotes a plastic surgeon saying that women bring in pages from porn, and want to "look like this." With so many women being forced into genital mutilation in other nations, women are lining up and paying for a version of it here. Sometimes there are really no words for the kind of idiocy women will subject themselves to, such as costly procedures (which all carry some health risks) in order to conform to some absurd supposed norm.

    Here's a PubMed search on the topic, only 47 articles. By contrast, there are nearly 5000 on rhinoplasty (nose jobs), giving you an idea of how much this procedure has been studied, and probably by extension, read about by your surgeon.
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    Bribing Women to be Sterilized

    Via feministing, I learned about this group offering drug-addicted women $200 to be sterilized. Project Prevention's stated mission is to "offer(s) cash incentives to women that are addicted to drugs and/or alcohol to use long-term or permanent birth control." The first problem I have with this is that this group does not provide women with funding for drug treatment, but is "currently writing to 40 of our birth control clients on a monthly basis. She sends them cards of encouragement applauding their efforts to get or stay clean. We have referred over 200 men and women to drug treatment programs..." Ooh, letters, good stuff. At least they mention referrals, but it seems that they really are not effectively advising treatment based on the statement, "Our organization has offered to relocate several addicts to drug treatment programs we located for them (none accepted)." The second problem I have is their logic for not funding treatment, that "For every [baby born to an addict] we prevent from being conceived, society saves millions of dollars that can be put towards drug treatment." This doesn't make sense because there is no straight line between the two; nobody is measuring how many children aren't born, figuring out how much it would have cost to care for them, and putting that money into drug treatment. If hospitals don't spend the money in the NICU, they're spending it somewhere else, and they have no idea how this group hypothetically played into the equation, and the money doesn't get re-routed to drug treatment. The third problem is that they're not targeting any education or sterilization to men (where sterilization could possibly be reversed) - they're only targeting women, at least according to their home page.

    The main problem I have with this, though, is two-fold. First, they're effectively sending the coercive message to drug-addicted women, "Hey, we've got $200 for you if you get sterilized." Women with drug problems may use this solution in order to have money for drugs, when what they really need is drug treatment, effectively ignoring the women's own health in order to "save the children." The sterilization option, which vulnerable women may be influenced to choose, is permanent, not allowing them to become pregnant if they wish to in the future, even in a clean future. Second, the women can only opt for sterilization or long-term birth control methods such as IUDs or Norplant, which really may not be the best choice for an individual woman. The IUD, for example, carries risks of uterine perforation and pelvic inflammatory disease. Women should be allowed to choose a birth control method based on their individual needs and health risks, not a "cash incentive." EngenderHealth has a nice overview of informed choice and consent, which involves educating women about all of their choices, and not introducing any bias. The ethical and informed consent issues related to what Project Prevention is doing are really overwhelming, and it's hard to imagine how they have been allowed to continue.

  • Article from BBC News

    FYI-This group apparently has chapters in Memphis and Nashville...
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  • Wednesday, August 10, 2005

    I can't help you with this search...

    In my site stats, I found that one visitor came here as the result of a web search as follows: "Why are all of the pieces of EMail I receive about health issues about women's health issues." The librarian in me cringes at this search string, but is also very amused. This is a question with an answer wrapped up in society, politics, the nature/history of the health care system, and how women are feeling about whether their bodily rights and healthcare needs are being respected (or maybe just someone who signed up with iVillage...). It's not an answer someone is going to find in my links to smoking cessation resources, or through a simple web query, even if it was phrased in a way a search engine could understand. While I got a giggle from the search, I'd be interested in your comments on whether there is actually a serious answer to this initially amusing question.
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    More on Lung Cancer: Screening, Quitting Smoking, and Attitudes

    Screening:
    Sharon Cobb posted on lung cancer screening recently, indicating that spiral CT is the best thing for early lung cancer detection. I did some searching, and the existing studies do seem to find that this is a good tool for early detection. The literature also includes, however, discussion of a high rate of false positives from this test, whether the test is cost-effective, and the limited evidence that early detection with this test actually reduces mortality. This may turn out to be a great test for catching lung cancer early and reducing mortality, but based on the literature it seems to be in "ask your doctor" territory, not "demand this procedure" territory.
  • PubMed search on spiral CT for lung cancer diagnosis
  • PubMed search for practice guidelines on lung cancer diagnosis
  • This NEJM article on lung cancer screening is not online for free yet, but you can view the citations, many of which are free online and good reviews of this topic.
  • Information on screening from the National Cancer Institute

    Quitting:
  • MedlinePlus provides some good links on smoking cessation.
  • MayoClinic.com provides this nice overview of products to help people quit smoking, such as lozenges and the patch, with pros and cons for all of them.
  • For the non-smokers, here are do's and don'ts for you while your smoker tries to quit.

    Attitudes:
    The New York Times today has an article called "Nonsmokers can be Lung Cancer Victims, Too," which touches briefly on the stigma associated with lung cancer. The article makes the point nicely that the concept of "innocent" and "not so innocent" victims may not be a particularly useful one, and all people with cancer need support. While it may be true that many lung cancer deaths could be prevented if people didn't smoke, there are also other preventable diseases that don't seem to evoke the same, "Oh, too bad about the disease, but you DID do this..." sentiments. One thing that comes to mind is HIV/AIDS. In general, I think that people have a much more civilized reaction to sexually transmitted diseases. I for one have never heard anyone say, "Oh, you have AIDS? Did you have sex?" in the accusatory tone lung cancer patients may experience. Or, "Oh, you were hurt in a car wreck? That's what you get for driving." In my humble opinion, anyone suffering from cancer, another disease, or an injury needs and deserves the love and support of their friends and family, and true friends and otherwise decent people should and will be caring and supportive, no matter what the cause of a current ill state.

    Next time, I'll put away the soapbox and just bring you the sweet, sweet info. :)
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  • Monday, August 08, 2005

    Farewell Peter: Lung Cancer & Smoking Resources

    You've probably all heard by now that Peter Jennings died yesterday of lung cancer. It seemed like a good day to put up a list of resources on lung cancer and smoking.

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    Thursday, August 04, 2005

    Morning Edition Story on Emergency Contraception

    Morning Edition ran a story this morning on "Emergency Contraception and the Pregnancy Debate." Emergency contraception is classified as, um, contraception because it prevents pregnancy, but don't do anything if a woman is already pregnant, which is defined by implantation of a fertilized egg and detected through resulting hormones that start to be produced afterward. Guests for this story debate whether this is an accurate picture of when pregnancy begins, which has implications for whether people consider this drug as contraception or as an abortifacent. For additional info, MayoClinic.com has an overview of what happens at different times following fertilization.

    The radio piece is interesting in terms of the viewpoints presented. Perhaps the oddest one was the former physician who claimed that he didn't prescribe emergency contraception, not because he opposed it, but because he didn't know how it worked. The story doesn't explain why he didn't find out... Here's one of the many available web resources that explain, among other things, how it works.
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    Ranking Tennessee Women's Health

    I just found this report, from the National Center for Health Statistics, titled "Women's Health and Mortality Chartbook" (data from 1999-2002) It includes state profiles (PDF) that rank the prevalence of a cause of death compared to other states and describes the percentage of women who have certain health risks or received specific preventive services. A high ranking (i.e., closer to 50) on the 1-50 scale means that more women die of something compared to women in other states.

    Among the results:
  • TN ranks 28th or worse for every cause of death listed
  • TN ranks 50th for influenza/pneumonia deaths and stroke deaths, 49th for coronary heart disease, 45th for unintentional injuries(!), 42nd for diabetes-related causes of death, and 33rd for suicide.
  • 49% of women in TN had no leisure time physical activity, 40% were obese, and 48% had high blood pressure
  • TN women fared better on preventive services, with 70% of women or more receiving services such as pap smears, cholesterol tests, routine checkups, routine physicals, and mammograms.
  • TN did rank best (1) for binge drinking, and 2nd best for eating 5+ fruits/vegetables per day.
  • 88.9% had health insurance coverage

    I can't help looking at these numbers and thinking that there is a gap somewhere if women are regularly receiving preventive services, but health risks and cause of death rankings aren't better. The problem could be the in health care system, or the women's genetics and lifestyles, but I'm guessing it's a little of both.

    TN-specific health statistics (PDF) from the TN Dept of Health.
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  • Wednesday, August 03, 2005

    Welcome Part 2: Hey, Guys, Hang on One Minute!

    Welcome NiT readers, who may be visiting this site for the first time thanks to the link that Brittney graciously posted. For those of you who haven't seen it, Nashville is Talking is a great site for finding out what other Nashville bloggers are discussing, and I've found many interesting blogs and posts on non-Nashville topics through it.

    Right about now, some of the men among you may be thinking, "Eh, another woman blogger talking about her stuff." As mentioned in my inaugural post, my aim is to present reliable resources, news, legislation, and new research on numerous aspects of women's health, i.e. not just periods, not just reproduction.

    Because many of the topics here are not just one-day news cycle items, you may find valuable information linked among older posts. I encourage you to check them out. You might just be able to offer some good links to the women in your life, to provide some information to your wife, daughters, sisters, and friends when they really need it.

    To the women finding this blog, I hope you will find something interesting and useful among the links and stories presented here. I welcome your suggestions and comments, and I am happy to search for information and post on it if you have a particular health issue you'd like to know more about - just send me an email, and I'll see what resources I can come up with.

    Just to reiterate, I'm not a physician, but a medical librarian-in-training. Digging up good health info and filtering out the junk is what we do. Feel free to ask a question any time.

    Welcome, and thanks for reading!
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    Tuesday, August 02, 2005

    Study Suggests Ovary Removal May Increase Heart Disease Risk

    A study in the current issue of Obstetrics and Gynecology suggests that oophorectomy (ovary removal) during hysterectomies for benign (non-cancerous) conditions may increase women's risk of heart disease. The study looked at published data to model women's survival rates over time if their ovaries were removed - this is often done in order to prevent the possibility of ovarian cancer. The study was NOT a clinical trial following actual women over time; I would expect a study of that type to be done before the authors' conclusions could be considered completely reliable. The authors do note this limitation, but are skeptical that such a large, long-term study will be done.

    The most notable suggestion of the study was that heart disease risk is lowered the longer women delay having their ovaries removed (the authors also looked at other outcomes). If the study holds up, it will be important because heart disease currently kills more women than any cancers according to CDC data, and the National Cancer Institute indicates that ovarian cancer is the 5th leading cause of cancer death in women.

    Bottom line: If ovary removal is not necessary during your hysterectomy, talk to your doctor about the benefits and risks of leaving them in.

    Summary from MedlinePlus
    Also from MedlinePlus, information on ovarian cancer, heart disease, and hysterectomy
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    Monday, August 01, 2005

    Wisconsin to ban birth control on college campuses?

    I read on TGW this morning that the Wisconsin Assembly has passed a bill forbidding UW campuses from prescribing or dispensing birth control. Assembly Bill 343 states,
    (b) No person whom the board employs or with whom the board contracts to provide health care services to students registered in the system may advertise the availability of, transmit a prescription order for, or dispense a hormonal medication or combination of medications that is administered only after sexual intercourse for the postcoital control of fertility to a registered student or to any other person entitled to receive university health care services.
    (c) In addition to the prohibition under par. (b), no person may advertise, prescribe, or dispense a hormonal medication or combination of medications that is administered only after sexual intercourse for the postcoital control of fertility on system property, except for property leased under s.233.04.

    At first glance, this language might seem to prohibit the prescribing or dispensing of emergency contraception only, not "regular" birth control. A statement by UW-River Falls' director of student health, however, outlines concerns that this bill could also prohibit the prescription of other oral contraceptives (same drug, different doses). The Wisconsin Attorney General also released an opinion on the legislation, including the statement that the legislation was sufficiently vague to also prohibit other contraceptives.

    The bill now moves to the Wisconsin Senate; this story indicates that the Governor has stated that he will ban the measure if it passes the Senate.

    A good summary of the situation is available here - the opinion piece clearly outlines some of the reasons this is problematic. It also points out that part of the idea behind the bill was the assumption that providing EC promoted promiscuity. Apparently UW women, who I suspect are largely 18+, are responsible enough to make decisions about going to war, voting, driving, attending college, etc., but not enough to be trusted with their bodies and sexual lives.

    Meanwhile, UW-Madison reports that at least 13 forcible sexual offenses occured on campus in 2004.

    Planned Parenthood of Wisconsin also released a statment on the legislation, and provides a list of their WI health centers.
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